Information Collection

Local Health Department Capacity and Readiness

IC 201410 under ICR 201512-0920-010 · OMB 0920-0941.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Local Health Department Capacity and Readiness	Form
Local Health Department Capacity and Readiness Atmt_SS_Local_Health_Department_Capacity_and_Readiness_Survey[1].docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	None	Local Health Department Capacity and Readiness	Atmt_SS_Local_Health_Department_Capacity_and_Readiness_Survey[1].docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-16	16
Annual IC Time Burden (Hours)	-32	32
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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