OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Health Center COVID-19 Vaccine Program

OMB 0906-0062 ยท HHS/HRSA.

OMB 0906-0062

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 5 PCAs Survey Tool Questions 7-21.pdfForm and Instruction
Form 5 Primary Care Associations (PCAs) Survey Tool QuestionsForm and Instruction
Form 1 HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 8-16-21.pdfForm and Instruction
Form 1 HC COVID-19 Vaccine Prgrm Conditions of Participation AgreementForm and Instruction
Form 4 ADDENDUM Health Center COVID-19 Vaccine ProgramForm and Instruction
Form 4 Addendum to COVID-19 Data Collection Survey ToolForm and Instruction
Form 3 HC_Data_Collection_Tool_08_27_2021_Final.docxForm and Instruction
Form 3 COVID-19 Data Collection Survey ToolForm and Instruction
Form 2 Health Center COVID-19 Vaccine Program Readiness Assessment 8-21Form and Instruction
Form 2 Readiness Assessment ToolForm and Instruction
SUPPORTING STATEMENT - 0062 revision.docxSupporting Statement A
HRSA AADM to OIRA AA Memo_FINAL.pdf Supplementary Document
Primary Care Associations (PCAs) Survey Tool Questions Form and Instruction
Primary Care Associations (PCAs) Survey Tool Questions Form and Instruction
HC COVID-19 Vaccine Prgrm Conditions of Participation Agreement 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
Addendum to COVID-19 Data Collection Survey Tool Form and Instruction
COVID-19 Data Collection Survey Tool Form and Instruction
COVID-19 Data Collection Survey Tool Form and Instruction
Readiness Assessment Tool Form and Instruction
Readiness Assessment Tool Form and Instruction
Readiness Assessment Tool Instruction

All Historical Document Collections

Historical document collections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