Survey Instrument

High-Level Survey to Assess Current Capacity to Manage Wildlife Diseases by State, Tribal, and Territorial Governments Under the American Rescue Plan Act of 2021

Documents and Forms

Document Name Document Type
Wildlife Health Capacity Assessment Tool Final w-PRA 03242022.docx Other-Draft Survey Instrument
Wildlife Health Capacity Assessment Tool Final w-PRA 03242022_omb Final 04052022.docx Other-Draft Survey Instrument

Information Collection (IC) Details

IC Title:	Survey Instrument	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Draft Survey Instrument			Wildlife Health Capacity Assessment Tool Final w-PRA 03242022_omb Final 04052022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 630	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	630	630
Annual IC Time Burden (Hours)	210	210
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.