OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Health Center COVID-19 Vaccine Program

OMB 0906-0062 · HHS/HRSA.

OMB 0906-0062

Latest Forms, Documents, and Supporting Material

Document Name
Form 5 Primary Care Associations (PCAs) Survey Tool Questions Form and Instruction
Form 1 HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement Form and Instruction
Form 4 Addendum to COVID-19 Data Collection Survey Tool Form and Instruction
Form 3 COVID-19 Data Collection Survey Tool Form and Instruction
Form 2 Readiness Assessment Tool Form and Instruction
SUPPORTING STATEMENT - 0062 revision.docx Supporting Statement A
HRSA AADM to OIRA AA Memo_FINAL.pdf Supplementary Document
Primary Care Associations (PCAs) Survey Tool Questions Form and Instruction
HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement Form and Instruction
Addendum to COVID-19 Data Collection Survey Tool Form and Instruction
COVID-19 Data Collection Survey Tool Form and Instruction
Readiness Assessment Tool Form and Instruction

All Historical Document Collections

202108-0906-001 Approved without change	Revision of a currently approved collection	2021-08-19
202102-0906-002 Approved without change	New collection (Request for a new OMB Control Number)	2021-02-17