Capability 10

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Capability 9

Plans for Crisis Standards of Care (CSC)

Procedures in place for information exchange between public health and health care sectors regarding:

a. Staffing status

b. Alternative care sites

c. Bed status

d. Critical service/infrastructure status

e. Essential medical supplies and services

f. Patient census

Plans describe family reunification for displaced persons

Public reporting burden of this collection of information is estimated to average 120 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).