Information Collection

Los Angeles County - Public Health Center Guests

IC 228843 under ICR 201807-0920-011 · OMB 0920-1221.

Documents and Forms

Document Name Document Type
Form 0920-1221 Los Angeles County - Public Health Center Guests Form and Instruction
0920-1221 Los Angeles County Community Emergency Preparedness Surv Survey-Proposed Change 30MAR2018.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Los Angeles County - Public Health Center Guests	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1221	Los Angeles County Community Emergency Preparedness Survey	Survey-Proposed Change 30MAR2018.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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