Information Collection

STLT Ebola-Related Activities

IC 213041 under ICR 201402-0920-018 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

STLT Ebola-Related Activities

Agency IC Tracking Number:

14AYL

IC Status: New

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.