STLT Ebola-Related Activities

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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
C_Assessment_Web Version.docx Other-WORD
B_Assessment_ Word Version.docx Other-Screen Shots
STLT Ebola-SSA.docx Sup Sta A IC Document
STLT Ebola-SSB.docx SupSta B IC Document
A. National Standards for PHEP Capabilities.pdf Att A_Public Health Preparedness Capabilities IC Document
D_Notification Email.docx Att D_Notification Email IC Document
E_Reminder Email.docx Att E_Reminder Email IC Document

Information Collection (IC) Details

IC Title:	STLT Ebola-Related Activities	Agency IC Tracking Number:	14AYL

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
Other-WORD			C_Assessment_Web Version.docx		Yes	Yes	Fillable Printable
Other-Screen Shots			B_Assessment_ Word Version.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 262	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	262	262
Annual IC Time Burden (Hours)	44	44
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sup Sta A	STLT Ebola-SSA.docx	09/09/2014
SupSta B	STLT Ebola-SSB.docx	09/09/2014
Att A_Public Health Preparedness Capabilities	A. National Standards for PHEP Capabilities.pdf	09/09/2014
Att D_Notification Email	D_Notification Email.docx	09/09/2014
Att E_Reminder Email	E_Reminder Email.docx	09/09/2014

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