Assessment of the National Health Security Index for Public Health Preparedness

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material.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
Assessment of the National Health Security Index for Public Health Preparedness Form
Attachment C - CDC NHSPI Semi-Structured Interview Guide.docx Other-Interview guide
National Health Security Preparedness Index Assessment Attachment B - CDC NHSPI Online Assessment Web Version.docx Form
National Health Security Preparedness Index Assessment - Attachment A - CDC NHSPI Online Assessment Instrument Word Version.docx Form
INDEX-USE-SSA.docx Supporting Statement A IC Document
INDEX-USE-SSB.docx Supporting Statement B IC Document
Attachment D - CDC NHSPI Online Assessment Information Letter.docx Online assessment information letter IC Document
Attachment E - CDC NHSPI Online Assessment Follow-Up Protocol.docx Online assessment follow-up IC Document
Attachment F - CDC NHSPI Interview Information Letter.docx Interview information letter IC Document
Attachment G - CDC NHSPI Interview Follow-Up Protocol.docx Interview follow-up IC Document

Information Collection (IC) Details

IC Title:	Assessment of the National Health Security Index for Public Health Preparedness	Agency IC Tracking Number:	0920-0879-20PH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	National Health Security Preparedness Index Assessment	Attachment B - CDC NHSPI Online Assessment Web Version.docx	Yes	Yes	Fillable Fileable
Form	none	National Health Security Preparedness Index Assessment - word	Attachment A - CDC NHSPI Online Assessment Instrument Word Version.docx	Yes	Yes	Fillable Fileable
Other-Interview guide			Attachment C - CDC NHSPI Semi-Structured Interview Guide.docx	Yes	No	Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 320	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 86 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	320	320
Annual IC Time Burden (Hours)	290	290
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A	INDEX-USE-SSA.docx	06/15/2020
Supporting Statement B	INDEX-USE-SSB.docx	06/15/2020
Online assessment information letter	Attachment D - CDC NHSPI Online Assessment Information Letter.docx	06/15/2020
Online assessment follow-up	Attachment E - CDC NHSPI Online Assessment Follow-Up Protocol.docx	06/15/2020
Interview information letter	Attachment F - CDC NHSPI Interview Information Letter.docx	06/15/2020
Interview follow-up	Attachment G - CDC NHSPI Interview Follow-Up Protocol.docx	06/15/2020

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