Information Collection

Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel

IC 272108 under ICR 202603-0920-006 · OMB 0920-0666.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel	Form and Instruction
57.215 Seasonal Survey on Influenza Vaccination Programs for He 57.215 Seasonal Survey on Influenza Vaccination Programs for Healthcare Personnel.docx	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	57.215				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 15,426

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	15,426	15,426
Annual IC Time Burden (Hours)	11,570	11,570
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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