Information Collection

Verification of Service Dog Immunization

IC 216606 under ICR 201505-2900-007 · OMB 2900-0831.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0831 can be found here:

Documents and Forms

Document Name Document Type
Verification of Service Dog Immunization Form.docx Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Verification of Service Dog Immunization	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Verification of Service Dog Immunization Form.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,500	1,500
Annual IC Time Burden (Hours)	125	125
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.