OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

The HRSA Community Based Outreach Reporting Module

OMB 0906-0064 · HHS/HRSA.

OMB 0906-0064

Latest Forms, Documents, and Supporting Material

Document Name
Form 4 Vaccine Site Data - Outreach to Community Members Form - Booster Vaccines Form and Instruction
Form 3 General Outreach Activities for Community Members Form Form and Instruction
Form 2 Vaccine Site Data - Outreach to Community Members Form Form and Instruction
Form 1 Community Outreach Worker Profile Form Form and Instruction
Supporting Statement A - CBO Program FINAL 09-22-2021.docx Supporting Statement A
Transmittal Memo to OIRA from HRSA CBO PRA Approval Request 07.09.2021 approved.pdf Supplementary Document
Vaccine Site Data - Outreach to Community Members Form - Booster Vaccines Form and Instruction
General Outreach Activities for Community Members Form Form and Instruction
Vaccine Site Data - Outreach to Community Members Form Form and Instruction
Community Outreach Worker Profile Form Form and Instruction

All Historical Document Collections

202109-0906-002 Approved without change	Revision of a currently approved collection	2021-09-30
202107-0906-001 Approved without change	New collection (Request for a new OMB Control Number)	2021-07-12