Information Collection

RSB Product and STLT Preparedness Assessment

IC 216011 under ICR 201412-0920-011 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Att E InstrumentMSWord.docx Other-WORD
Att F Instrument Web Version.docx Other-Screenshots
RSB-ASSESS-SSA.041015.docx Supporting Statement IC Document
RSB-ASSESS-SSB.docx Supporting Statement B IC Document
Att A - RSB Roundtables.docx Att A_RSB Roundtables IC Document
Att B - PHEP Grantees.docx Att B_PHEP Grantees IC Document
Att C – Radiation Control Program Officials.docx Att C_Radiation Control Program Officials IC Document
Att D - REP Participants.docx Att D_REP Participants IC Document
Att G Notification Email.docx Att G_Notification Email IC Document
Att H Reminder Email Day 14.docx Att H_Reminder Email Day 14 IC Document
Att I Reminder Email Day 21.docx Att I_Reminder Email Day 21 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	RSB Product and STLT Preparedness Assessment	Agency IC Tracking Number:	15ZJ

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			Att E InstrumentMSWord.docx		Yes	Yes	Fillable Printable
Other-Screenshots			Att F Instrument Web 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: 336	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	336	336
Annual IC Time Burden (Hours)	112	112
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement	RSB-ASSESS-SSA.041015.docx	04/27/2015
Supporting Statement B	RSB-ASSESS-SSB.docx	04/27/2015
Att A_RSB Roundtables	Att A - RSB Roundtables.docx	04/27/2015
Att B_PHEP Grantees	Att B - PHEP Grantees.docx	04/27/2015
Att C_Radiation Control Program Officials	Att C â Radiation Control Program Officials.docx	04/27/2015
Att D_REP Participants	Att D - REP Participants.docx	04/27/2015
Att G_Notification Email	Att G Notification Email.docx	04/27/2015
Att H_Reminder Email Day 14	Att H Reminder Email Day 14.docx	04/27/2015
Att I_Reminder Email Day 21	Att I Reminder Email Day 21.docx	04/27/2015

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