Information Collection

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

IC 223813 under ICR 201709-0920-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Questionnaire - Drought Community Assessment for Public Health Emergency Response -- 2016 Community Assessment for Public Health Emergency Response (CASPER) addressing the California Drought – Mariposa County, 2016	Form and Instruction
Referral - Community Assessment for Public Health Emergency Response To Drought 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: Modified

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
	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

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.