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Healthcare Workers Core Module
Survey of Healthcare Workers' Health and Safety Practices
OMB: 0920-0860
IC ID: 192663
OMB.report
HHS/CDC
OMB 0920-0860
ICR 201004-0920-008
IC 192663
( )
Documents and Forms
Document Name
Document Type
Form 10
Healthcare Workers Core Module
Form and Instruction
10 Healthcare Workers Core Module
Attachment I9_Core Module_TC_72310.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Healthcare Workers Core Module
Agency IC Tracking Number:
Is this a Common Form?
No
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
10
Healthcare Workers Core Module
Attachment I9_Core Module_TC_72310.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
20,520
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
20,520
0
20,520
0
0
0
Annual IC Time Burden (Hours)
6,840
0
6,840
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.