Information Collection

Healthcare Preparedness Program (hpp) Needs Assessment Questionnaire

IC 217165 under ICR 201504-0990-001 · OMB 0990-0391.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0391 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
0990-0391NeedsAssessment_questionnaire_2015(cys).pdf	Other-questionnaire
0990-0391- HPP Needs Assessment Questionnaire .doc HPP Needs Assessment	IC Document

IC Title:

HEALTHCARE PREPAREDNESS PROGRAM (HPP) NEEDS ASSESSMENT QUESTIONNAIRE

Agency IC Tracking Number:

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-questionnaire			0990-0391NeedsAssessment_questionnaire_2015(cys).pdf		Yes	Yes	Fillable Fileable

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

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)	31	31
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HPP Needs Assessment	0990-0391- HPP Needs Assessment Questionnaire .doc	06/23/2015

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