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

California Drought - Mariposa County, 2016 (Quarter 4)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	Agency IC Tracking Number:	0920-1036-17AD

IC Status: Modified

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
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 %

	Requested	Previously Approved
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

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.