Information Collection

Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3

IC 238970 under ICR 201610-0920-009 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1154 Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3	Form and Instruction
0920-1154 Survey Disaster Planners Att_1_ Survey_Disaster_Planners_instrument3_4Dec2019_revised.docx	Form and Instruction
0920-1154-ParticipatoryMapping-GenICTemplate_OMB_4Dec2019_instrument3_revised.docx GenIC Template	IC Document
Att_2_Invitation Letter_instrument3_25Nov19.docx Invitation Letter	IC Document
Att_3_ IRB HSPH_Exemption_Letter_10Oct2019.pdf Exemption Letter	IC Document
Att_4_Harvard_6972 Exempt Granted Memo 29March17.docx IRB Exemption	IC Document
SSA_ParticipatoryMapping3_OMB_4Dec_2019_revised.docx SSA	IC Document
SSB_ParticipatoryMapping_OMB_instrument3_191218.docx SSB	IC Document

IC Title:

Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness â Phase 3

Agency IC Tracking Number:

0920-1154-20EQ

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	0920-1154	Survey Disaster Planners	Att_1_ Survey_Disaster_Planners_instrument3_4Dec2019_revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Template	0920-1154-ParticipatoryMapping-GenICTemplate_OMB_4Dec2019_instrument3_revised.docx	12/18/2019
Invitation Letter	Att_2_Invitation Letter_instrument3_25Nov19.docx	12/18/2019
Exemption Letter	Att_3_ IRB HSPH_Exemption_Letter_10Oct2019.pdf	12/18/2019
IRB Exemption	Att_4_Harvard_6972 Exempt Granted Memo 29March17.docx	12/18/2019
SSA	SSA_ParticipatoryMapping3_OMB_4Dec_2019_revised.docx	12/18/2019
SSB	SSB_ParticipatoryMapping_OMB_instrument3_191218.docx	12/18/2019

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