Form Approved OMB
Approval No. 0920-1352 Expiration
Date: 10/31/2024
FE, FSE, or incident
a. Type of vaccine administered (pandemic influenza, seasonal influenza, novel coronavirus, other)
b. Method of vaccine administered (vaccinated, simulated, hybrid)
c. Participating CWG
d. SMEs involved (select all that apply)
e. SME role
f. Method of notification of targeted CWG
g. Communication platforms used for staff notification
h. Call notification process
Public reporting burden of
this collection of information is estimated to average 12
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).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Garcia, Albert (CDC/DDPHSIS/CPR/OD) |
File Modified | 0000-00-00 |
File Created | 2022-03-21 |