Information Collection

Wastage Upload Report

IC 261185 under ICR 202307-0915-004 · OMB 0915-0395.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 3 Wastage Upload Report	Form
Form 3 Wastage Upload Report Wastage Upload Report	Form
3 Wastage Upload Report Appendix C_Wastage_Upload_Template.xlsx	Form
3 Wastage Upload Report Appendix C_Wastage_Upload_Template.xlsx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form	3				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 57

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,964	2,964
Annual IC Time Burden (Hours)	682	682
Annual IC Cost Burden (Dollars)	0	0

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.

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