[OPHDST] HMIS and IIS Integration Survey to Improve Vaccination Rate Tracking among People Experiencing Homelessness (PEH)

[OADC] CDC Usability and Digital Content Testing

Documents and Forms

Document Name Document Type
Form 0920-1050 [OPHDST] HMIS and IIS Integration Survey to Improve Vaccination Rate Tracking among People Experiencing Homelessness (PEH) Form and Instruction
0920-1050 Homeless Management Information System (HMIS) and Immuni HMIS Survey Questions and intro_outreach language.docx Form and Instruction
0920-1050 HMIS IIS Template_01312024.docx 0920-1050 GenIC Request Template IC Document

Information Collection (IC) Details

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: Unchanged

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

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 %

	Requested	Previously Approved
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	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.