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Federal forms, ICRs, and supporting documents

Information Collection Request

VALIDATION OF PNEUMOCOCCAL VACCINATION STATUS AMONG HAWAII MEDICARE ELIGIBLE

ICR 199108-0920-003 · OMB 0920-0291 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
111019 VALIDATION OF PNEUMOCOCCAL VACCINATION STATUS AMONG HAWAII MEDICARE ELIGIBLE Migrated
ICR Details
0920-0291 199108-0920-003
Historical Active
HHS/CDC
VALIDATION OF PNEUMOCOCCAL VACCINATION STATUS AMONG HAWAII MEDICARE ELIGIBLE
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/31/1991
Retrieve Notice of Action (NOA) 08/01/1991
  Inventory as of this Action Requested Previously Approved
12/31/1991 12/31/1991
1,125 0 0
267 0 0
0 0 0
THIS IS A STUDY TO VALIDATE THE VACCINATION STATUS (PNEUMOCOCCAL VACCINE) OF A SAMPLE OF MEDICARE BENEFICIARIES. THE BENEFICIARIES AS WELL AS THEIR HEALTH CARE PROVIDERS WILL BE SURVEYED. THIS SURVEY PART OF A LARGER STUDY TO EXAMINE THE CLINICAL EFFECTIVENESS OF PNEUMOCOCCAL VACCINATION.
None
None
No
1
IC Title Form No. Form Name
VALIDATION OF PNEUMOCOCCAL VACCINATION STATUS AMONG HAWAII MEDICARE ELIGIBLE
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,125 0 0 1,125 0 0
Annual Time Burden (Hours) 267 0 0 267 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/01/1991