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

[OS] 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⚠️ Notice: This information collection may be referencing outdated material.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- 23DF [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 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
Att1-TEST Game Layout.png Att1-TEST Game Layout 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 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
GenICRequestTemplate_TEST.docx GenICRequestTemplate_TEST IC Document
SSA-CPR-ThisIsATEST.docx SSA-CPR-ThisIsATEST IC Document
SSB_ThisATest.docx SSB_ThisATest IC Document

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920- 23DF	Attachment B_Immediate Post Exercise Survey Questions	Attachment B_Immediate Post Exercise Survey Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-23DF	Attachment C_Follow Up Survey Questions	Attachment C_Follow Up Survey Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-23DA	Attachment D_Focus Group Script	Attachment D_Focus Group Script.docx	Yes	Yes	Fillable Fileable

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 %

	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

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

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