Five-year Dispensing - Full Scale Exercise or Incident

Form Approved

OMB Approval No. 0920-xxxx

Expiration Date: xx/xx/xxxx

Five-year Dispensing – Full Scale Exercise or Incident

Dispensing FSE or incident

a. Public health responders used to run PODs/DVCs (yes or no)

b. Staff received initial prophylaxis as part of exercise or incident (yes or no)

c. SMEs involved (select all that apply)

d. PODs/DVCs participating in exercise or incident

Public reporting burden of this collection of information is estimated to average 6 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).