Public Health Preparedness Capabilities Assessment (PHEPCAPSUR)

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

⚠️ Notice: This information collection may be referencing outdated material.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 A - PHEP Assessment Word Version.docx Other-WORD
Attachment B PHEP Assessment WebVersion.docx Other-Screenshots
PHEPCAPSUR-SSA.docx SupSta-A IC Document
PHEPCAPSUR-SSB.docx SupSta_B IC Document
Att. C - Advanced Notification Email.docx Att C_Adv Notification Email IC Document
Att. D - Launch Email.docx Att D_Launch E-mail IC Document
Att. E - Reminder Email.docx Att E_Reminder E-mail IC Document

Information Collection (IC) Details

IC Title:	Public Health Preparedness Capabilities Assessment (PHEPCAPSUR)	Agency IC Tracking Number:	15AQO

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 A - PHEP Assessment Word Version.docx		Yes	Yes	Paper Only
Other-Screenshots			Attachment B PHEP Assessment WebVersion.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 62	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	62	62
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
SupSta-A	PHEPCAPSUR-SSA.docx	07/09/2015
SupSta_B	PHEPCAPSUR-SSB.docx	07/09/2015
Att C_Adv Notification Email	Att. C - Advanced Notification Email.docx	07/09/2015
Att D_Launch E-mail	Att. D - Launch Email.docx	07/09/2015
Att E_Reminder E-mail	Att. E - Reminder Email.docx	07/09/2015

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