Healthcare System Stress Pulse Query

The Hospital Preparedness Program

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
0990-0391 Major Incident-Specific Collection Pulse Survey 10-1-15.doc Other-survey
0990-0391Ongoing Collection Pulse Survey 9-28-15.doc Other-survey
0990-0391 Pulse Survey-HPP Generic Clearance-OMB 10-2-15.doc Healthcare System Stress Pulse Query IC Document

Information Collection (IC) Details

IC Title:	Healthcare System Stress Pulse Query	Agency IC Tracking Number:

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-survey			0990-0391 Major Incident-Specific Collection Pulse Survey 10-1-15.doc		Yes	Yes	Fillable Fileable
Other-survey			0990-0391Ongoing Collection Pulse Survey 9-28-15.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Healthcare System Stress Pulse Query	0990-0391 Pulse Survey-HPP Generic Clearance-OMB 10-2-15.doc	10/20/2015

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