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⚠️ Notice: This information collection may be referencing outdated material.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

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:

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 %

	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

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.