Information Collection

State and Local Public Health Planners: Pandemic Preparedness Readiness

IC 216036 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⚠️ Notice: This information collection may be referencing outdated material.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
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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.