Information Collection

Capability 10: Medical Surge

IC 247378 under ICR 202202-0920-015 · OMB 0920-1352.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1352 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Capability 10: Medical Surge	Form and Instruction
Capability 10 Att20-Capability 10.docx	Form and Instruction
Capability 10 Att20-Capability 10.docx	Form and Instruction
0920-1352 Capability 10 01MAR2022 Att20-Capability 10-clean.docx	Form and Instruction
0920-1352 Capability 10 01MAR2022 Att20-Capability 10-clean.docx	Form and Instruction

IC Title:

Capability 10: Medical Surge

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	n/a	Capability 10	Att20-Capability 10.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-1352	Capability 10 01MAR2022	Att20-Capability 10-clean.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 62

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	62	62
Annual IC Time Burden (Hours)	124	124
Annual IC Cost Burden (Dollars)	3,931	3,931

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.