View Information Collection (IC)

View Information Collection (IC)

IC Title:	57.213 Healthcare Personnel Influenza Vaccination Monthly Summary	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	57.213	Healthcare Personnel Influenza Vaccination Monthly Summary	57.213_HPSFluMonthlySummary_BLANK_092110.ppt		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	0	-36,000	0	36,000
Annual IC Time Burden (Hours)	0	0	0	-72,000	0	72,000
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
5_HPS_fluVacc	5_HPS_fluVacc.pdf	12/05/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.