Capability 8

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Capability 8

The process to request assistance for medical countermeasures (MCM) assets involving

a. Federal disaster declaration

b. Isolated, individual, or time-critical to the jurisdiction

c. Coordination with tribal governments (if applicable)

POD security plans in place

Process for dispensing MCM in POD and dispensing vaccination clinics (DVC) sites include

a. Flow diagram

b. Algorithm for dispensing medical countermeasures

c. Record/log of drugs dispensed

d. Investigational New Drug (IND)

e. Emergency Use Authorization (EUA)

MCM procedures for cold chain management

General point-of-dispensing (POD) information

• POD name

• POD operation type (open/closed)

• POD planning type (primary, back-up, tertiary)

• Address

• POD used as antibiotic dispensing clinic (y/n)

• POD used as dispensing vaccination clinic (y/n)

• Written agreement in place (y/n)

POD Detail

• Type of facility (academic institution, athletic complex, community center, government facility, etc.)

• Primarily walk through, drive through, combination (select 1)

• Staffing is based on a tiered approach (y/n)

• Total staff needed for antibiotic dispensing operation

• Total staff currently identified for antibiotic dispensing operation

• Total staff needed for vaccine administration clinic/DVC (if applicable)

• Total staff currently identified for antibiotic dispensing operation

Public reporting burden of this collection of information is estimated to average 420 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).