Questionnaire - paper-based

Availability, Use, and Public Health Impact of Emergency Supply Kits among Disaster-Affected Populations

Documents and Forms

Document Name Document Type
Questionnaire - paper-based Form
Survey questionnaire P_Att1_Survey_PaperBased_20200924 clean.pdf Form

Information Collection (IC) Details

IC Title:	Questionnaire - paper-based	Agency IC Tracking Number:	0920-20QN

Is this a Common Form? No		IC Status: Unchanged

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
Form	none	Survey questionnaire	P_Att1_Survey_PaperBased_20200924 clean.pdf		Yes	No	Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 333	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	333	333
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	4,282	4,282

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.