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FluSurv-NET Hospitalization Surveillance Project History Fax Form (Children/Adults)
[NCEZID] Emerging Infections Program
OMB: 0920-0978
IC ID: 231111
OMB.report
HHS/CDC
OMB 0920-0978
ICR 202309-0920-002
IC 231111
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0978 can be found here:
2023-12-29 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 0920-0978
FluSurv-NET Hospitalization Surveillance Project History Fax Form (Children/Adults)
Form and Instruction
0920-0978 APPENDIX 5A.2: PROVIDER ADULT VACCINATION HISTORY REQUEST LETTER/FORM
Att14- FluSurv-Net_Provider Vaccination HIstory_Children_Adult.pdf
Form and Instruction
Information Collection (IC) Details
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