View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	[OPHDST] HMIS and IIS Integration Survey to Improve Vaccination Rate Tracking among People Experiencing Homelessness (PEH)	Agency IC Tracking Number:	0920-1050-24CV

IC Status: New

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 and Instruction	0920-1050	Homeless Management Information System (HMIS) and Immunization Information System (IIS) Data Sharing/Data Partnership Survey	HMIS Survey Questions and intro_outreach language.docx	N/A	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	550	0	550	0	0	0
Annual IC Time Burden (Hours)	92	0	92	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
0920-1050 GenIC Request Template	0920-1050 HMIS IIS Template_01312024.docx	02/05/2024

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