Information Collection

Medical Countermearsure Training Needs Assessment

IC 231555 under ICR 201711-0920-012 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment E - Training Needs Electronic Assessment, Web Version Screenshots.docx	Other-Electronic Version
Attachment G - Virtual Group Interview Sign-up Form, Web Version Screenshots.docx	Other-Electronic version
Attachment I - Virtual Group Interview Discussion Guide, Web Version Screenshots.docx	Other-Electronic Version
Attachment D - Training Needs Electronic Assessment, Word Version.docx Att D_Training Needs Assessment, WORD Version	IC Document
Attachment F - Virtual Group Interview Sign-up Form, Word Version.docx Att F_Virtual Group Interview SIgn-Up, WORD Version	IC Document
Attachment H - Virtual Group Interview Discussion Guide, Word Version.docx Att H_Virtual Group Interview DIscussion Guide, WORD Version	IC Document
Attachment A - MCM Coordinator Common Responsibilities and Associated Skills.pdf Att A_MCM Coordinator - Common Responsibilities and Associated Skills	IC Document
Attachment B - Sample of MCM Officials Table.docx Att B_Sample of MCM Officials Table	IC Document
Attachment C - Respondent Universe.docx Att C_Respondent Universe	IC Document
Attachment J - Electronic Assessment Invitation Email.docx Att J_Electronic Assessment Invitational Email	IC Document
Attachment K - MCM Training Needs Assessment Advertisement.docx Att K_MCM Training Needs Assessment Advertisement	IC Document
Attachment L - Electronic Assessment Reminder 1 Email.docx Att L_Electronic Assessment Reminder 1 Email	IC Document
Attachment M - Electronic Assessment Reminder 2 Email.docx Att M_Electronic Assessment Reminder 2 Email	IC Document
Attachment N - Reminder Phone Call Script.docx Att N_Reminder Phone Call Script	IC Document
Attachment O - Group Interview Notification Email.docx Att O_Group Interview Notification Email	IC Document
Attachment P - Group Interview Reminder Email.docx Att P_Group Interview Reminder Email	IC Document
MCM-NEEDS-SSA. FINAL.docx Supporting Statement A	IC Document
MCM-NEEDS-SSB. FINAL.docx Supporting Statement B	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Medical Countermearsure Training Needs Assessment

Agency IC Tracking Number:

18ADS

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Electronic Version	Attachment E - Training Needs Electronic Assessment, Web Version Screenshots.docx	Yes	Yes	Fillable Fileable
Other-Electronic version	Attachment G - Virtual Group Interview Sign-up Form, Web Version Screenshots.docx	Yes	Yes	Fillable Fileable
Other-Electronic Version	Attachment I - Virtual Group Interview Discussion Guide, Web Version Screenshots.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,174

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	2,174	2,174
Annual IC Time Burden (Hours)	637	637
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att D_Training Needs Assessment, WORD Version	Attachment D - Training Needs Electronic Assessment, Word Version.docx	05/23/2018
Att F_Virtual Group Interview SIgn-Up, WORD Version	Attachment F - Virtual Group Interview Sign-up Form, Word Version.docx	05/23/2018
Att H_Virtual Group Interview DIscussion Guide, WORD Version	Attachment H - Virtual Group Interview Discussion Guide, Word Version.docx	05/23/2018
Att A_MCM Coordinator - Common Responsibilities and Associated Skills	Attachment A - MCM Coordinator Common Responsibilities and Associated Skills.pdf	05/23/2018
Att B_Sample of MCM Officials Table	Attachment B - Sample of MCM Officials Table.docx	05/23/2018
Att C_Respondent Universe	Attachment C - Respondent Universe.docx	05/23/2018
Att J_Electronic Assessment Invitational Email	Attachment J - Electronic Assessment Invitation Email.docx	05/23/2018
Att K_MCM Training Needs Assessment Advertisement	Attachment K - MCM Training Needs Assessment Advertisement.docx	05/23/2018
Att L_Electronic Assessment Reminder 1 Email	Attachment L - Electronic Assessment Reminder 1 Email.docx	05/23/2018
Att M_Electronic Assessment Reminder 2 Email	Attachment M - Electronic Assessment Reminder 2 Email.docx	05/23/2018
Att N_Reminder Phone Call Script	Attachment N - Reminder Phone Call Script.docx	05/23/2018
Att O_Group Interview Notification Email	Attachment O - Group Interview Notification Email.docx	05/23/2018
Att P_Group Interview Reminder Email	Attachment P - Group Interview Reminder Email.docx	05/23/2018
Supporting Statement A	MCM-NEEDS-SSA. FINAL.docx	05/24/2018
Supporting Statement B	MCM-NEEDS-SSB. FINAL.docx	05/24/2018

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