CDC Guidelines for the Field Triage of Injured Patients: National Evaluation

Surveys of State, Tribal, Local and Territorial (STLT) Governmental Health Agencies

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
CDC Guidelines for the Field Triage of Injured Patients: National Evaluation Form
Assessment of CDC Guidelines for the Field Triage of Inj FTG_ATTACH-C_Survey_Instrument_101811.docx Form
FTG_ATTACH-A_2006_FT_Guidelines_2011-09-27.pdf Att A - Field Triage Guidelines IC Document
FTG_ATTACH-B_Estimated_FT_Adoption_2011-09-27.docx Att B - Adoption Status Map IC Document
FTG_ATTACH-D_Participation_Email_101811.docx Att D - Participation Email IC Document
FTG_ATTACH-E_Participation_Reminder_Email- 101811.docx Att E - Reminder Email IC Document
FTG_Supporting_Statement-PART-A_101811.docx Supporting Statement A IC Document
FTG_Supporting_Statement_PART-B_101811.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	CDC Guidelines for the Field Triage of Injured Patients: National Evaluation	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	none	Assessment of CDC Guidelines for the Field Triage of Injured Patients	FTG_ATTACH-C_Survey_Instrument_101811.docx		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	0	0	0	0	0
Annual IC Time Burden (Hours)	17	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att A - Field Triage Guidelines	FTG_ATTACH-A_2006_FT_Guidelines_2011-09-27.pdf	10/19/2011
Att B - Adoption Status Map	FTG_ATTACH-B_Estimated_FT_Adoption_2011-09-27.docx	10/19/2011
Att D - Participation Email	FTG_ATTACH-D_Participation_Email_101811.docx	10/19/2011
Att E - Reminder Email	FTG_ATTACH-E_Participation_Reminder_Email- 101811.docx	10/19/2011
Supporting Statement A	FTG_Supporting_Statement-PART-A_101811.docx	10/19/2011
Supporting Statement B	FTG_Supporting_Statement_PART-B_101811.docx	10/19/2011

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