Information Collection

PHEM Tool

IC 262113 under ICR 202506-0920-004 · OMB 0920-1417.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PHEM Tool	Form and Instruction
PHEM Tool PHEM Tool	Form and Instruction
Form 0920-1417 PHEM Tool - rev 12JUN2025 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
0920-1417 PHEM Tool - rev 12JUN2025 PHEM Tool-2025proposed modified tool.xlsx	Form and Instruction
0920-1417 PHEM Tool - rev 12JUN2025 PHEM Tool-2025proposed modified tool.xlsx	Form and Instruction

IC Title:

PHEM Tool

Agency IC Tracking Number:

0920-23EH

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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				Yes	Yes	Fillable Fileable
Form and Instruction	0920-1417			N/A	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 %

table that charts list of burden
	Approved	Previously Approved
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

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.

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