OMB control number
The HRSA Community Based Outreach Reporting Module
OMB 0906-0064 ยท HHS/HRSA.
OMB 0906-0064
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 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All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202109-0906-002 | Revision of a currently approved collection | 2021-09-30 | Approved without change | |
| 202107-0906-001 | New collection (Request for a new OMB Control Number) | 2021-07-12 | Approved without change |