Information Collection

State-level Administrators - Survey

IC 210900 under ICR 201403-0920-013 · OMB 0920-1025.

Documents and Forms

Document Name Document Type
State-level Administrators - Survey Form
Survey of State-level Administrators Atmt E - Survey of State Administrators.docx Form
Survey of State Administrators - screenshots Atmt L - State level survey.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State-level Administrators - Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	none	Survey of State-level Administrators	Atmt E - Survey of State Administrators.docx		Yes	Yes	Fillable Fileable
Form	none	Survey of State Administrators - screenshots	Atmt L - State level survey.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4	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 Agency Discretion
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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