Information Collection

Assessment of the National Health Security Index for Public Health Preparedness

IC 242255 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.