Capability 5

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: 07/xx/20xx

Capability 5

During a mass fatality incident describe public health’s role for

a. Electronic death registration system (EDRS) reporting (select lead, support, or no role)

b. Issuance of death certificates (select lead, support, or no role)

c. Identification of triggers that prompt PH engagement or activation

d. Identification of sites for interim storage and disposition of human remains (select lead, support, or no role)

e. Personal protective equipment (PPE) training for medical examiner/coroner (ME/C) fatality management (select lead, support, or no role)

f. Implementing a tracking system for the identification of recovered remains (select lead, support, or no role)

Fatality management operation plans include

a. Partner communication

b. Surveillance (select lead, support, or no role)

c. Mortality reporting (select lead, support, or no role)

d. Supplies (select lead, support, or no role)

e. Family call/assistance centers (select lead, support, or no role)

f. e. Behavioral/ Mental health services (select lead, support, or no role)

Plans for antemortem data describe

a. Victim identification data collection methods (select lead, support, or no role)

b. Family notification (select lead, support, or no role)

c. Dissemination (select lead, support, or no role)

Public reporting burden of this collection of information is estimated to average 90 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).