Crisis Re-Entry Questionnaire Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 OMB Clearance_Crisis Re-Entry Questionnaire Survey_Mar2016.doc Other-questionnaire
0990-0391 OMB Clearance_Crisis Re-Entry Questionnaire Survey_Mar2016.doc Crisis Re-Entry Questionnaire Survey IC Document

Information Collection (IC) Details

IC Title:	Crisis Re-Entry Questionnaire Survey	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-questionnaire			0990-0391 OMB Clearance_Crisis Re-Entry Questionnaire Survey_Mar2016.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Crisis Re-Entry Questionnaire Survey	0990-0391 OMB Clearance_Crisis Re-Entry Questionnaire Survey_Mar2016.doc	03/24/2016

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