Pilot Test of an Interview Protocol Designed to Evaluate Emergency Preparedness and Response Capabilities

Questionnaire and Data Collection Testing, Evaluation, and Research for the Agency for Healthcare Research and Quality

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0935-0124 can be found here:

Documents and Forms

Document Name Document Type
Form Form #1 Pilot Test of an Interview Protocol Designed to Evaluate Emergency Preparedness and Response Capabilities Form and Instruction
Form #1 Emergency Preparedness and Response Capabilities Intervi Attachment A -- Emergency Prepardness and Response Capabilities Interview Protocol.docx Form and Instruction
SS Part A -- Pilot Test of an Interview Protocol Designed to Evaluate Emergency Prepardness Response Capabilities 11-15-2013.docx SS Part A -- Pilot Test of an Interview Protocol Designed to Evaluate Emergency Prepardness Response Capabilities 11-15-2013 IC Document

Information Collection (IC) Details

IC Title:	Pilot Test of an Interview Protocol Designed to Evaluate Emergency Preparedness and Response Capabilities	Agency IC Tracking Number:

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 and Instruction	Form #1	Emergency Preparedness and Response Capabilities Interview Protocol	Attachment A -- Emergency Prepardness and Response Capabilities Interview Protocol.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	60	0	0	0	0	0
Annual IC Time Burden (Hours)	60	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SS Part A -- Pilot Test of an Interview Protocol Designed to Evaluate Emergency Prepardness Response Capabilities 11-15-2013	SS Part A -- Pilot Test of an Interview Protocol Designed to Evaluate Emergency Prepardness Response Capabilities 11-15-2013.docx	11/19/2013

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