Capability 1

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: 07/xx/20xx

Capability 1

Date of most recently conducted jurisdictional risk assessment (JRA) or equivalent

Hazards identified in the assessment

Process in place for transporting people in an emergency

Evidence of process to integrate trusted spokesperson or agent representing individuals with access and functional needs to deliver public health messages

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-xxxx).