Form 0920-1352 Vaccination for Critical Workforce Groups and Disproport

Form Approved

OMB Approval No. 0920-1352

Expiration Date: 10/31/2024

Vaccination for Critical Workforce Groups and Disproportionately Impacted Populations (VAC)

VAC1 Critical workforce groups (CWG) and disproportionately impacted populations (DIP) prioritized for COVID-19 vaccine

VAC2.a-b PHEP Role determining prioritized populations for limited supply of COVID-19 vaccination

a. At the start of vaccine availability

b. During the refinement of priority vaccination groups

VAC2.c Vaccine administration capacity

VAC2.d Equitable access to vaccine services

VAC3.a-e PHEP role communicating targeted vaccination plans with

a. Incident management stakeholders

b. Vaccine administrators

c. CWG employers for directed outreach

d. DIP community partners for culturally sensitive message development

e. DIP community partners to amplify directed outreach

Public reporting burden of this collection of information is estimated to average 189 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1352).

 

VAC4.a-k. Vaccine management and administration activities)

a. Vaccine supply

b. Vaccine shipment

c. Vaccine transport

d. Vaccine storage and handling (including cold chain management)

e. DVC preparation and supplies

f. DVC locations

g. Vaccine preparation

h. Vaccine administration

i. Vaccine documentation

j. Vaccine adverse event tracking

1. Post DVC actions, documentation, or demobilization

b. PHEP capabilities supported COVID-19 vaccination efforts

c. Monitored Best Practices for Temporary, Off-Site, or Satellite Clinics

VAC5.a-d Vaccine Administrators

a. Recruitment

b. Credentialing

c. Training

d. Safety and Health Monitoring

VAC5.e Vaccination administrators were recruited from

VAC6.a-k COVID-19 Vaccination Activities (for each select either performed without challenges, performed with some challenges,

performed with major challenges, unable to perform, or not applicable)

a. Vaccine supply

b. Vaccine shipment

c. Vaccine transport

d. Vaccine storage and handling (including cold chain management)

e. DVC preparation and supplies (equipment)

f. DVC locations

g. Vaccine preparation

h. Vaccine administration staff (personnel resources)

i. Vaccine documentation (monitoring and tracking)

j. Vaccine adverse event tracking

k. Post DVC actions, documentation, or demobilization

VAC6.l COVID-19 Vaccination Campaign Strength

VAC6.m COVID-19 Vaccination Campaign Area for Improvement

VAC6.n COVID-19 Vaccination Campaign root cause analysis