HHS Region VI Virtual Tabletop Exercise Assessment

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⚠️ Notice: This information collection may be referencing outdated material.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
HHS Region VI Virtual Tabletop Exercise Assessment Form
Exercise Findings Form Attachment A - Exercise Findings Form.docx Form
Exercise Feedback Form Attachment B - Exercise Participant Feedback Form.docx Form
O2C2 Supporting_Statement_A_VTTX.docx Supporting Statement A IC Document
O2C2 Supporting_Statement_B_VTTX.docx Supporting Statement B IC Document
Attachment C - Notification Email.docx Notification Email IC Document
Attachment D - Reminder Email.docx Reminder Email IC Document

Information Collection (IC) Details

IC Title:	HHS Region VI Virtual Tabletop Exercise Assessment	Agency IC Tracking Number:	16BCU

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	none	Exercise Findings Form	Attachment A - Exercise Findings Form.docx		Yes	Yes	Fillable Fileable
Form	none	Exercise Feedback Form	Attachment B - Exercise Participant Feedback Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	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	140	140
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	O2C2 Supporting_Statement_A_VTTX.docx	08/31/2016
Supporting Statement B	O2C2 Supporting_Statement_B_VTTX.docx	08/31/2016
Notification Email	Attachment C - Notification Email.docx	08/31/2016
Reminder Email	Attachment D - Reminder Email.docx	08/31/2016

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