Information Collection

Local Health Department Capacity and Readiness

IC 201410 under ICR 201207-0920-010 · OMB 0920-0941.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form SS Local Health Department Capacity and Readiness	Form
SS Local Health Department Capacity and Readiness Atmt SS LHD Capacity and Readiness.docx	Form
Atmt MMM LHD Capacity Readiness Screenshots.pdf Atmt MMM LHD Capacity Readiness Screenshots	IC Document

IC Title:

Local Health Department Capacity and Readiness

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SS	Local Health Department Capacity and Readiness	Atmt SS LHD Capacity and Readiness.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	16	16
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Atmt MMM LHD Capacity Readiness Screenshots	Atmt MMM LHD Capacity Readiness Screenshots.pdf	02/28/2012

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