Information Collection

[CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)

IC 259152 under ICR 202506-0920-010 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- 23DF [CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)	Form and Instruction
Form 0920- 23DF Attachment B_Immediate Post Exercise Survey Questions [CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)	Form and Instruction
Form 0920-23DF Attachment C_Follow Up Survey Questions [CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)	Form and Instruction
Form 0920-23DA Attachment D_Focus Group Script [CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)	Form and Instruction
0920- 23DF Attachment B_Immediate Post Exercise Survey Questions Attachment B_Immediate Post Exercise Survey Questions.docx	Form and Instruction
0920- 23DF Attachment B_Immediate Post Exercise Survey Questions Attachment B_Immediate Post Exercise Survey Questions.docx	Form and Instruction
0920-23DF Attachment C_Follow Up Survey Questions Attachment C_Follow Up Survey Questions.docx	Form and Instruction
0920-23DF Attachment C_Follow Up Survey Questions Attachment C_Follow Up Survey Questions.docx	Form and Instruction
0920-23DA Attachment D_Focus Group Script Attachment D_Focus Group Script.docx	Form and Instruction
0920-23DA Attachment D_Focus Group Script Attachment D_Focus Group Script.docx	Form and Instruction
Att1-TEST Game Layout.png Att1-TEST Game Layout	IC Document
Att1-TEST Game Layout.png Att1-TEST Game Layout	IC Document
Attachment 2 HSR Determination.pdf Attachment 2 HSR Determination	IC Document
Attachment 2 HSR Determination.pdf Attachment 2 HSR Determination	IC Document
Attachment A_Participant Information.docx Attachment A_Participant Information	IC Document
Attachment A_Participant Information.docx Attachment A_Participant Information	IC Document
Attachment B_Immediate Post Exercise Survey Questions.docx Attachment B_Immediate Post Exercise Survey Questions	IC Document
Attachment B_Immediate Post Exercise Survey Questions.docx Attachment B_Immediate Post Exercise Survey Questions	IC Document
Att1a-TEST Rulebook_v1.1.pdf Att1a-TEST Rulebook_v1.1	IC Document
Att1a-TEST Rulebook_v1.1.pdf Att1a-TEST Rulebook_v1.1	IC Document
GenICRequestTemplate_TEST.docx GenICRequestTemplate_TEST	IC Document
GenICRequestTemplate_TEST.docx GenICRequestTemplate_TEST	IC Document
SSA-CPR-ThisIsATEST.docx SSA-CPR-ThisIsATEST	IC Document
SSA-CPR-ThisIsATEST.docx SSA-CPR-ThisIsATEST	IC Document
SSB_ThisATest.docx SSB_ThisATest	IC Document
SSB_ThisATest.docx SSB_ThisATest	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[CPR] Evaluation on Acceptability and Effectiveness of Pilot Project This is a Tabletop Exercise Simulation Tool (T.E.S.T.)

Agency IC Tracking Number:

0920-1154-23DF

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920- 23DF	Yes	Yes	Fillable Fileable
Form and Instruction	0920-23DF	Yes	Yes	Fillable Fileable
Form and Instruction	0920-23DA	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	2,750	2,750
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att1-TEST Game Layout		03/14/2023
Attachment 2 HSR Determination		03/14/2023
Attachment A_Participant Information		03/14/2023
Attachment B_Immediate Post Exercise Survey Questions		03/14/2023
Att1a-TEST Rulebook_v1.1		03/14/2023
GenICRequestTemplate_TEST		03/14/2023
SSA-CPR-ThisIsATEST		03/14/2023
SSB_ThisATest		03/14/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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