Information Collection

Questionnaire - paper-based

IC 245446 under ICR 202101-0920-016 · OMB 0920-1344.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1344 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Questionnaire - paper-based	Form
Survey questionnaire P_Att1_Survey_PaperBased_20200924 clean.pdf	Form
Survey questionnaire P_Att1_Survey_PaperBased_20200924 clean.pdf	Form

IC Title:

Questionnaire - paper-based

Agency IC Tracking Number:

0920-20QN

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Survey questionnaire	P_Att1_Survey_PaperBased_20200924 clean.pdf		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: 333

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	333	333
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	4,282	4,282

Documents for IC

table that charts IC Documents
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.