Document Name Document Type
State and Local Public Health Planners: Pandemic Preparedness Readiness Form and Instruction
PHEP Contact and Assessment Instrument/Email F. PHEP Contact Assessment Instrument and Email.docx Form and Instruction
Section I: Vaccination Planning G2. Section I_Vaccination Planning.pdf Form and Instruction
Section III: Medical Care & Countermeasures I2. Section III_Medical Care Countermeasures.pdf Form and Instruction
Section II: Epidemiology and Laboratory H2. Section II_Epidemiology and Laboratory.pdf Form and Instruction
Section IV: Healthcare Systems J2. Section IV_Healthcare Systems.pdf Form and Instruction
Section V: Community Mitigation K2. Section V_Community Mitigation.pdf Form and Instruction
Section VI: Public Information and Communication L2. Section VI_Public Information and Communication.pdf Form and Instruction
Section VII: Public Health and Immunization Workforce M2. Section VII_Public Health and Immunization Workforce.pdf Form and Instruction
A. PAHPA 2006.pdf Authorizing Legislation PL 113-5 IC Document
B. PHAB Standards and Measures.pdf Public Health Accreditation Board Standards and Measures IC Document
C. ESF 08.pdf Emergency Support Function 8 IC Document
D. PHEP Funding Opportunity Announcement.pdf PHEP Interim Progress Report IC Document
E. CDC PHEP Capabilities.pdf Executive Summary PHEP Capabilities IC Document
G1. Section I_Vaccination Planning.doc Section I - Vaccination Planning - WORD IC Document
H2. Section II_Epidemiology and Laboratory.pdf Section II Epidemiology and Laboratory - WORD IC Document
J1. Section IV_Healthcare Systems.doc Section IV - Healthcare Systems - WORD IC Document
K1. Section V_Community Mitigation.doc Section V - Community Mitigation - WORD IC Document
L1. Section VI_Public Information and Communication.doc Section VI - Public Information and Communication - WORD IC Document
M1. Section VII_Public Health and Immunization Workforce.doc Section VII - Public Health and Immunization Workforce - WORD IC Document
N. Invitation Emails.docx Invitation Emails Module I-VII IC Document
O. Reminder Email 7 Day.docx Reminder Email - Day 7 IC Document
P. Reminder Email 14 Day.docx Reminder Email - Day 14 IC Document
PanPrep-SSA.docx Supporting Statement A - PanPrep IC Document
PanPrep-SSB.docx Supporting Statement B - PanPrep IC Document
I1. Section III_Medical Care Countermeasures.doc Section III Medical Care Countermeasures - WORD IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State and Local Public Health Planners: Pandemic Preparedness Readiness	Agency IC Tracking Number:	15ZN

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
Form and Instruction	None	PHEP Contact and Assessment Instrument/Email	F. PHEP Contact Assessment Instrument and Email.docx	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section I: Vaccination Planning	G2. Section I_Vaccination Planning.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section III: Medical Care & Countermeasures	I2. Section III_Medical Care Countermeasures.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section II: Epidemiology and Laboratory	H2. Section II_Epidemiology and Laboratory.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section IV: Healthcare Systems	J2. Section IV_Healthcare Systems.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section V: Community Mitigation	K2. Section V_Community Mitigation.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section VI: Public Information and Communication	L2. Section VI_Public Information and Communication.pdf	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Section VII: Public Health and Immunization Workforce	M2. Section VII_Public Health and Immunization Workforce.pdf	None	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 496	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	496	496
Annual IC Time Burden (Hours)	341	341
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation PL 113-5	A. PAHPA 2006.pdf	04/10/2015
Public Health Accreditation Board Standards and Measures	B. PHAB Standards and Measures.pdf	04/10/2015
Emergency Support Function 8	C. ESF 08.pdf	04/10/2015
PHEP Interim Progress Report	D. PHEP Funding Opportunity Announcement.pdf	04/10/2015
Executive Summary PHEP Capabilities	E. CDC PHEP Capabilities.pdf	04/10/2015
Section I - Vaccination Planning - WORD	G1. Section I_Vaccination Planning.doc	04/10/2015
Section II Epidemiology and Laboratory - WORD	H2. Section II_Epidemiology and Laboratory.pdf	04/10/2015
Section IV - Healthcare Systems - WORD	J1. Section IV_Healthcare Systems.doc	04/10/2015
Section V - Community Mitigation - WORD	K1. Section V_Community Mitigation.doc	04/10/2015
Section VI - Public Information and Communication - WORD	L1. Section VI_Public Information and Communication.doc	04/10/2015
Section VII - Public Health and Immunization Workforce - WORD	M1. Section VII_Public Health and Immunization Workforce.doc	04/10/2015
Invitation Emails Module I-VII	N. Invitation Emails.docx	04/10/2015
Reminder Email - Day 7	O. Reminder Email 7 Day.docx	04/10/2015
Reminder Email - Day 14	P. Reminder Email 14 Day.docx	04/10/2015
Supporting Statement A - PanPrep	PanPrep-SSA.docx	04/10/2015
Supporting Statement B - PanPrep	PanPrep-SSB.docx	04/10/2015
Section III Medical Care Countermeasures - WORD	I1. Section III_Medical Care Countermeasures.doc	04/10/2015

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

State and Local Public Health Planners: Pandemic Preparedness Readiness

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

OMB: 0920-0879

IC ID: 216036

View Information Collection (IC)