Readiness Assessment Tool

Health Center COVID-19 Vaccine Program

Documents and Forms

Document Name Document Type
Form 2 Readiness Assessment Tool Form and Instruction
INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf Instruction
INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf Instruction
2 Health Center COVID-19 Vaccine Program Readiness Assessm FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf Form and Instruction
2 Health Center COVID-19 Vaccine Program Readiness Assessm FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Readiness Assessment Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	2	Health Center COVID-19 Vaccine Program Readiness Assessment 8-21	FORM 2 - Health Center COVID-19 Vaccine Program Readiness Assessment 8-21.pdf		Yes	Yes	Fillable Fileable
Instruction			INSTRUCTION - HC COVID-19 Vaccine Pgrm Readiness Assessment User Guide.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,467	Number of Respondents for Small Entity: 1,467

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,467	103	1,364
Annual IC Time Burden (Hours)	734	52	682
Annual IC Cost Burden (Dollars)	0	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.