Information Collection

Capability 10: Medical Surge

IC 247378 under ICR 202411-0920-005 · OMB 0920-1352.

Documents and Forms

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

IC Title:

Agency IC Tracking Number:

0920-1352

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	0920-1352	Capability 10	Att20-Capability 10.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
	Requested	Program Change Due to Agency Discretion
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.