Information Collection

Vaccination for Critical Workforce Groups and Disproportionately Impacted Populations (VAC)

IC 251892 under ICR 202411-0920-005 · OMB 0920-1352.

Documents and Forms

Document Name Document Type
Form 0920-1352 Vaccination for Critical Workforce Groups and Disproportionately Impacted Populations (VAC) Form and Instruction
0920-1352 Vaccination for Critical Workforce Groups and Disproport Att43 - VAC Form.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Vaccination for Critical Workforce Groups and Disproportionately Impacted Populations (VAC)	Agency IC Tracking Number:	0920-1352

Is this a Common Form? No		IC Status: Modified

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 and Instruction	0920-1352	Vaccination for Critical Workforce Groups and Disproportionately Impacted Populations (VAC)	Att43 - VAC Form.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 62	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	62	62
Annual IC Time Burden (Hours)	143	143
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.