PHEM Tool

[CPR] Public Health Emergency Management Capacity Assessment Tool (PHEM TOOL)

Documents and Forms

Document Name Document Type
PHEM Tool Form and Instruction
PHEM Tool Att3 -PHEM Tool_final.xlsx Form and Instruction
PHEM Tool Att3 -PHEM Tool_final.xlsx Form and Instruction

Information Collection (IC) Details

IC Title:	PHEM Tool	Agency IC Tracking Number:	0920-23EH

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
Form and Instruction	n/a	PHEM Tool	Att3 -PHEM Tool_final.xlsx		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: 12	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	72	72
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.