Form Approved
OMB Approval No. 0920-xxxx
Expiration Date: 0x/xx/2021
Critical Contact SheetPrimary CDC PHEP specialist -
Backup CDC PHEP specialist or team lead -
U.S. Marshal -
Health department EOC -
*Health department EOC: 24/7 phone number -
Health department EOC: primary contact name -
Health department EOC: primary phone number -
Health department EOC: primary phone number -
COOP EOC: primary contact name -
EMA EOC: primary contact name -
Health commissioner, secretary of health, state health officer (SHO), ministry of health -
*PHEP Director -
*MCM Coordinator -
CHEMPACK coordinator -
Law enforcement agencies responsible for MCM security: security contact name
Backup law enforcement agency responsible for MCM security: security contact name
Distribution (RSS) lead, supervisor, or chief: name
Backup distribution lead: name
State Department of Health Public information Officer (back-up)
Influenza coordinator
Immunization coordinator
Laboratorian
Epidemiologist
Public reporting burden of this collection of information is estimated to average 80 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).
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Garcia, Albert (CDC/DDPHSIS/CPR/OD) |
File Modified | 0000-00-00 |
File Created | 2022-03-03 |