Facility Setup Drill

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Facility Setup Drill

Drill information

a. Type of facility (EOC, RSS, RDS/LDS, POD, DVC, congregate/shelter sites)

b. Name of facility

c. Extent of advanced notification (full, partial, none)

d. Target time for set up (in minutes)

e. Facility setup start date/time

f. Facility setup end date/time

Public reporting burden of this collection of information is estimated to average 45 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).