Information Collection

Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016

IC 223813 under ICR 201609-0920-010 · OMB 0920-1036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	Form and Instruction
Questionnaire - Drought Community Assessment for Public CA CASPER Drought Questionnaire 10-4-16.docx	Form and Instruction
Referral - Community Assessment for Public Health Emerge CA CASPER Drought Referral Form 10-4-16.docx	Form and Instruction
20160929 CDPH CASPER request Mariposa County CA.pdf CASPER Request - Mariposa Co.	IC Document
RqstAprvl 2016 CASPER Mariposa CA.pdf CASPER GenIC Request	IC Document
RDF 2016 CASPER Mariposa CA signed OS.pdf Non-Research Determination	IC Document
NationalDroughtActionPlanTaskTracker - Goal 3.docx National Drought Response Plan Task Tracker	IC Document
federal_drought_resilience_action_plan_2016.pdf Federal Action Plan of the National Drought Resilience Partnership	IC Document

IC Title:

Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought â Mariposa County, 2016

Agency IC Tracking Number:

0920-1036-17AD

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	NA	Questionnaire - Drought Community Assessment for Public Health Emergency Response -- 2016	CA CASPER Drought Questionnaire 10-4-16.docx	NA	No		Paper Only
Form and Instruction	NA	Referral - Community Assessment for Public Health Emergency Response To Drought	CA CASPER Drought Referral Form 10-4-16.docx	NA	No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,284

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	1,284	1,284
Annual IC Time Burden (Hours)	631	631
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CASPER Request - Mariposa Co.	20160929 CDPH CASPER request Mariposa County CA.pdf	10/05/2016
CASPER GenIC Request	RqstAprvl 2016 CASPER Mariposa CA.pdf	10/06/2016
Non-Research Determination	RDF 2016 CASPER Mariposa CA signed OS.pdf	10/06/2016
National Drought Response Plan Task Tracker	NationalDroughtActionPlanTaskTracker - Goal 3.docx	10/06/2016
Federal Action Plan of the National Drought Resilience Partnership	federal_drought_resilience_action_plan_2016.pdf	10/06/2016

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