0920-1352 Capability 8 01MAR2022

Form Approved

OMB Approval No. 0920-1352

Expiration Date: 10/31/2024

Capability 8

Process to request assistance for medical countermeasures (MCM) assets involving

1. Federal disaster declaration

2. No federal disaster declaration (possible state declaration)

3. Isolated, individual, or time-critical to the jurisdiction

4. Coordination with tribal government(s) (if applicable)

c.

POD security plans in place

Process for dispensing MCM in POD and dispensing vaccination clinics (DVC) sites include

a. Flow diagram

b. Algorithm for dispensing medical countermeasures

c. Record/log of drugs dispensed

d. Investigational New Drug (IND) protocols

e. Emergency Use Authorization (EUA) protocols

MCM procedures for cold chain management

General point-of-dispensing (POD) information

• POD name

• POD operation type

• POD planning type

• Address 1

• Address 2

• City

• County

• Zip code

• Country

• POD used as antibiotic dispensing clinic

• POD used as dispensing vaccination clinic

• Written agreement in place

• Type of facility

POD Detail

• Estimated population who will visit the POD

• Primarily walk through, drive through, combination (select 1)

• Staffing is based on a tiered approach (y/n)

• Total staff needed for antibiotic dispensing operation

• Total staff currently identified for vaccine administration clinic DVC (if applicable)

• Total staff needed for vaccine administration clinic/DVC (if applicable)

• Total staff currently identified for antibiotic dispensing operation

Public reporting burden of this collection of information is estimated to average 420 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1352).