Information Collection

Wastage Upload Report

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

Documents and Forms

Document Name Document Type
Form 3 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Wastage Upload Report	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	3	Wastage Upload Report	Appendix C_Wastage_Upload_Template.xlsx		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 %

	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

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.