Information Collection

Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards

IC 254714 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22HH Att B Tabletop Exercise Question Bank and Guide (for Moderators) Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards	Form and Instruction
Form 0920-22HH Att C Tabletop Exercise CYSHCN Feedback Form Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards	Form and Instruction
Form 0920-22HH AttD - Exercise Evaluation Form and Guide - CYSHCN TTX Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards	Form and Instruction
0920-22HH Att B Tabletop Exercise Question Bank and Guide (for Mod Att B Tabletop Exercise Question Bank and Guide (for Moderators).docx	Form and Instruction
0920-22HH Att C Tabletop Exercise CYSHCN Feedback Form Att C Tabletop Exercise CYSHCN Feedback Form.docx	Form and Instruction
0920-22HH AttD - Exercise Evaluation Form and Guide - CYSHCN TTX AttD - Exercise Evaluation Form and Guide - CYSHCN TTX.docx	Form and Instruction
GenIC Request 0920-1154 Drexel CYSHCN TTX Jul2022.docx GenIC Request	IC Document
Appendix A - Situation Manual Home Assessment TTX.docx Appendix A - Situation Manual Home Assessment TTX	IC Document
Appendix A1 - TTX presentation exercise Fall 2022.pptx Appendix A1 - TTX presentation exercise Fall 2022	IC Document
Appendix B - Drexel TTX Save Date-Family Letter Fall 2022.docx Appendix B - Drexel TTX Save Date-Family Letter Fall 2022	IC Document
Appendix E - TTX confirmation - Stakeholders Fall 2022.docx Appendix E - TTX confirmation - Stakeholders Fall 2022	IC Document
Att A CDC Human Subjects Determination CYSHCN TTX.pdf Att A CDC Human Subjects Determination CYSHCN TTX	IC Document
SSA_Drexel_CYSHCN_TTX Jul2022v1.docx SSA	IC Document
SSB_Drexel_CYSHCN_TTX Jul2022.docx SSB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards

Agency IC Tracking Number:

0920-1154-22HH

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-22HH	Yes	Yes	Fillable Fileable
Form and Instruction	0920-22HH	Yes	Yes	Fillable Fileable
Form and Instruction	0920-22HH	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 32

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	32	32
Annual IC Time Burden (Hours)	102	102
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		07/19/2022
Appendix A - Situation Manual Home Assessment TTX		07/19/2022
Appendix A1 - TTX presentation exercise Fall 2022		07/19/2022
Appendix B - Drexel TTX Save Date-Family Letter Fall 2022		07/19/2022
Appendix E - TTX confirmation - Stakeholders Fall 2022		07/19/2022
Att A CDC Human Subjects Determination CYSHCN TTX		07/19/2022
SSA		07/19/2022
SSB		07/19/2022

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

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