Focus Group Testing of Two Health Hazard Evaluation Program Brochures

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0940 can be found here:

Documents and Forms

Document Name Document Type
Focus Group Testing of Two Health Hazard Evaluation Program Brochures Form
Focus Group Guide Task A Appendix B.docx Form
Telephone Screener Task A Appendix A (2).docx Form
CDC_NIOSH_HHE_Employers_042913_lowres.pdf Brochure - Employers IC Document
omb package task a_revised (3).docx Request for Approval IC Document
CDC HHE Emplyee Brochure_041013_lowres.pdf Brochure - Employee IC Document

Information Collection (IC) Details

IC Title:	Focus Group Testing of Two Health Hazard Evaluation Program Brochures	Agency IC Tracking Number:

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	none	Focus Group Guide	Task A Appendix B.docx		Yes	No	Fillable Printable
Form	none	Telephone Screener	Task A Appendix A (2).docx		Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	90	0	0	0	0	0
Annual IC Time Burden (Hours)	64	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Brochure - Employers	CDC_NIOSH_HHE_Employers_042913_lowres.pdf	06/27/2013
Request for Approval	omb package task a_revised (3).docx	06/27/2013
Brochure - Employee	CDC HHE Emplyee Brochure_041013_lowres.pdf	06/27/2013

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