View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Data Submission
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Form #4 Yes Yes Fillable Fileable

Health Immunization Management

 

70 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   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 70 0 -80 0 0 150
Annual IC Time Burden (Hours) 70 0 -80 0 0 150
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment F: Databases TEP List 07/25/2018
Attachment D: Data Submission Emails 07/25/2018
Attachment G: Example Screen Shots of Medical Office Survey on Patient Safety Culture Data Submission Web Site Information Collection 07/25/2018
Federal Register Notice 07/25/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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