Information Collection

DoD COVID-19 Vaccine Questionnaire

IC 248153 under ICR 202201-0720-002 · OMB 0720-0069.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0720-DCVQ-DoD COVID Vaccine Questionnaire 6.11.2021.docx	Other-Questionnaire
0720-DCVQ-DoD COVID Vaccine Questionnaire 6.11.2021.docx	Other-Questionnaire
0720-DCVQ-DoD COVID Vaccine Questionnaire-AudioCARE 6.11.2021.docx	Other-AudioCare System
0720-DCVQ-DoD COVID Vaccine Questionnaire-AudioCARE 6.11.2021.docx	Other-AudioCare System

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Questionnaire			0720-DCVQ-DoD COVID Vaccine Questionnaire 6.11.2021.docx		Yes	Yes	Fillable Fileable
Other-AudioCare System			0720-DCVQ-DoD COVID Vaccine Questionnaire-AudioCARE 6.11.2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 570,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	570,000	0	570,000
Annual IC Time Burden (Hours)	19,000	0	19,000
Annual IC Cost Burden (Dollars)	565,060	760	564,300

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.