Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 0920-1154 Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3 Form and Instruction
0920-1154 Survey Disaster Planners Att_1_ Survey_Disaster_Planners_instrument3_4Dec2019_revised.docx Form and Instruction
0920-1154-ParticipatoryMapping-GenICTemplate_OMB_4Dec2019_instrument3_revised.docx GenIC Template IC Document
Att_2_Invitation Letter_instrument3_25Nov19.docx Invitation Letter IC Document
Att_3_ IRB HSPH_Exemption_Letter_10Oct2019.pdf Exemption Letter IC Document
Att_4_Harvard_6972 Exempt Granted Memo 29March17.docx IRB Exemption IC Document
SSA_ParticipatoryMapping3_OMB_4Dec_2019_revised.docx SSA IC Document
SSB_ParticipatoryMapping_OMB_instrument3_191218.docx SSB IC Document

Information Collection (IC) Details

IC Title:	Participatory Mapping to Identify and Support At-Risk Populations in Emergency Preparedness – Phase 3	Agency IC Tracking Number:	0920-1154-20EQ

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	0920-1154	Survey Disaster Planners	Att_1_ Survey_Disaster_Planners_instrument3_4Dec2019_revised.docx		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: 40	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Template	0920-1154-ParticipatoryMapping-GenICTemplate_OMB_4Dec2019_instrument3_revised.docx	12/18/2019
Invitation Letter	Att_2_Invitation Letter_instrument3_25Nov19.docx	12/18/2019
Exemption Letter	Att_3_ IRB HSPH_Exemption_Letter_10Oct2019.pdf	12/18/2019
IRB Exemption	Att_4_Harvard_6972 Exempt Granted Memo 29March17.docx	12/18/2019
SSA	SSA_ParticipatoryMapping3_OMB_4Dec_2019_revised.docx	12/18/2019
SSB	SSB_ParticipatoryMapping_OMB_instrument3_191218.docx	12/18/2019

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