Information Collection

Data Files Submission

IC 209485 under ICR 202310-0935-003 · OMB 0935-0165.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form #4 Data Files Submission	Form and Instruction
Form #4 Screen Shots of Data Submission Attachment E -- Data Submission Screenshots.pdf	Form and Instruction
Form #4 Screen Shots of Data Submission Attachment E -- Data Submission Screenshots.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

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 and Instruction	Form #4	Screen Shots of Data Submission	Attachment E -- Data Submission Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	300	300
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.