Information Collection

CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies

IC 227992 under ICR 201510-0923-001 · OMB 0923-0047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0923-17AZF CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies	Form and Instruction
0923-17AZF Attachment B GPHEW NA Survey Text Attachment B GPHEW NA Survey Text.docx	Form and Instruction
0923-17AZF Attachment C GPHEW NA Survey Screenshots Attachment C GPHEW NA Survey Screenshots.docx	Form
Attachment A Recruitment Emails for GPHEW Needs Assessment.docx Attachment A Recruitment Emails for GPHEW Needs Assessment	IC Document
Request for Approval_GPHEW Needs Assessment Survey_.pdf Request for Approval_GPHEW Needs Assessment Survey_	IC Document

IC Title:

CDC/ATSDR Needs Assessment of GIS use in Public Health Emergencies

Agency IC Tracking Number:

0923-17AZF

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
Form and Instruction	0923-17AZF	Attachment B GPHEW NA Survey Text	Attachment B GPHEW NA Survey Text.docx		Yes	Yes	Fillable Fileable
Form	0923-17AZF	Attachment C GPHEW NA Survey Screenshots	Attachment C GPHEW NA Survey Screenshots.docx		Yes	Yes	Fillable Printable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	50	50
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A Recruitment Emails for GPHEW Needs Assessment	Attachment A Recruitment Emails for GPHEW Needs Assessment.docx	08/22/2017
Request for Approval_GPHEW Needs Assessment Survey_	Request for Approval_GPHEW Needs Assessment Survey_.pdf	08/23/2017

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