Participatory Mapping to Identify and Support at-Risk Populations in Emergency Preparedness

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Attachment _1_ Interview Guide_Community Leaders_Final_instrument_1.docx Other-Interview Guide
Harvard_GenIC_package_instrument_1.docx Request for Approval IC Document
Harvard_Supporting Statement A_instrument_1.docx Supporting Statement A IC Document
Harvard_Supporting Statement B_instrument_1.docx Supporting Statement B IC Document
Attachment_2_IRB Harvard exemption letter.pdf IRB Exemption IC Document
Attachment_3_Harvard_6972 Exempt Granted Memo.docx IRB Determination IC Document
Attachment_4_Invitation Letter_instrument_1.docx Invitation Letter IC Document

Information Collection (IC) Details

IC Title:	Participatory Mapping to Identify and Support at-Risk Populations in Emergency Preparedness	Agency IC Tracking Number:	17AEC

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-Interview Guide			Attachment _1_ Interview Guide_Community Leaders_Final_instrument_1.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Harvard_GenIC_package_instrument_1.docx	04/26/2017
Supporting Statement A	Harvard_Supporting Statement A_instrument_1.docx	04/26/2017
Supporting Statement B	Harvard_Supporting Statement B_instrument_1.docx	04/26/2017
IRB Exemption	Attachment_2_IRB Harvard exemption letter.pdf	04/26/2017
IRB Determination	Attachment_3_Harvard_6972 Exempt Granted Memo.docx	04/26/2017
Invitation Letter	Attachment_4_Invitation Letter_instrument_1.docx	04/26/2017

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