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Self-Reported General Work Environment and Health Questionnaire - Additional Data Collection
Musculoskeletal Disorder (MSD) Intervention Effectiveness in an Insurer-Supported Engineering Control Program
OMB: 0920-0907
IC ID: 215007
OMB.report
HHS/CDC
OMB 0920-0907
ICR 201409-0920-008
IC 215007
( )
Documents and Forms
Document Name
Document Type
Self-Reported General Work Environment and Health Questionnaire - Additional Data Collection
Form and Instruction
Self Reported General Work Environment and Heath Questio
Attachment H-4.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Self-Reported General Work Environment and Health Questionnaire - Additional Data Collection
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
None
Self Reported General Work Environment and Heath Questionnaire
Attachment H-4.docx
None
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
95 %
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
300
0
300
0
0
0
Annual IC Time Burden (Hours)
50
0
50
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.