Information Collection

Public Health Preparedness Capabilities Assessment (PHEPCAPSUR)

IC 217399 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.