Information Collection

Annual Healthcare Personnel Influenza Vaccination Summary (manual)

IC 246758 under ICR 202412-0920-018 · OMB 0920-0666.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0666 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summary (manual)	Form and Instruction
Form CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summary Annual Healthcare Personnel Influenza Vaccination Summary (manual)	Form and Instruction
CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summar 57.214 Healthcare Personnel Influenza Vaccination Summary.docx	Form and Instruction
CDC 57.214 Annual Healthcare Personnel Influenza Vaccination Summar 57.214 Healthcare Personnel Influenza Vaccination Summary.docx	Form and Instruction

IC Title:

Annual Healthcare Personnel Influenza Vaccination Summary (manual)

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	CDC 57.214			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 22,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	22,000	22,000
Annual IC Time Burden (Hours)	44,000	44,000
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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