Information Collection

Staff, Contractor, and Volunteer Reporting of New Vaccination (one-time)

IC 250754 under ICR 202206-0970-008 · OMB 0970-0583.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0970-0583 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Staff, Contractor, and Volunteer Reporting of New Vaccination (one-time)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 45 CFR 1302

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	75,000	16,884	58,116
Annual IC Time Burden (Hours)	50,003	11,259	38,744
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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