Information Collection

[CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies

IC 267344 under ICR 202507-0920-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
[CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies	Form
Pilot Evaluation Pre-Implementation Survey [CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies	Form
Pilot Evaluation POST-Implementation Survey [CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies	Form
Staff Focus Groups [CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies	Form
Leader Focus Groups [CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies	Form
Pilot Evaluation Pre-Implementation Survey AttA-SurveyPrePost_cleanv2.docx	Form
Pilot Evaluation Pre-Implementation Survey AttA-SurveyPrePost_cleanv2.docx	Form
Pilot Evaluation POST-Implementation Survey AttA-SurveyPrePost_cleanv2.docx	Form
Pilot Evaluation POST-Implementation Survey AttA-SurveyPrePost_cleanv2.docx	Form
Staff Focus Groups AttC-FocusGroup-Sta - clean.docx	Form
Staff Focus Groups AttC-FocusGroup-Sta - clean.docx	Form
Leader Focus Groups AttB-FocusGroup-lea - clean.docx	Form
Leader Focus Groups AttB-FocusGroup-lea - clean.docx	Form
ORR-0920-1154-GenIRequestTemplate-BuildingResilience.docx GenIC Request	IC Document
ORR-0920-1154-GenIRequestTemplate-BuildingResilience.docx GenIC Request	IC Document
ORR-SSA-1154-BuildingResilience (1).docx SSA	IC Document
ORR-SSA-1154-BuildingResilience (1).docx SSA	IC Document
ORR-SSB-1154-BuildingResilience.docx SSB	IC Document
ORR-SSB-1154-BuildingResilience.docx SSB	IC Document
Change Request Memo - EO14168 Template- GenIC-0920-1154 - ORR .docx Change Request Justification	IC Document
Change Request Memo - EO14168 Template- GenIC-0920-1154 - ORR .docx Change Request Justification	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[CPR] Pilots Evaluation of Interventions for Building Resilience for State and Local Health Department Staff Responding to Public Health Emergencies

Agency IC Tracking Number:

0920-25-0031

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	n/a	Yes	Yes	Fillable Fileable
Form	n/a	Yes	Yes	Fillable Fileable
Form	n/a	Yes	Yes	Fillable Fileable
Form	n/a	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,084

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	1,084	1,084
Annual IC Time Burden (Hours)	334	334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request		04/30/2024
SSA		04/30/2024
SSB		04/30/2024
Change Request Justification		06/17/2025

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

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