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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

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			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 %

table that charts list of burden
	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

table that charts IC Documents
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.