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Form 0920-0978 FluSurv Net Provider Vaccination History Fax Form
[NCEZID] Emerging Infections Program
Att14- FluSurv-Net_Provider Vaccination HIstory_Children_Adult
Influenza Hospitalization Surveillance Project Provider Vaccination History Fax Form (Children/Adults)
OMB: 0920-0978
OMB.report
HHS/CDC
OMB 0920-0978
ICR 202302-0920-009
IC 231111
Form 0920-0978 FluSurv Net Provider Vaccination History Fax Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0920-0978 can be found here:
2025-06-03 - No material or nonsubstantive change to a currently approved collection
2025-05-01 - No material or nonsubstantive change to a currently approved collection
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