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Att H_Employer Follow-up Survey
CDC Work@Health Advance Program: Evaluation of Train-the-Trainer and Advanced Technical Assistance Program
OMB: 0920-1077
IC ID: 216866
OMB.report
HHS/CDC
OMB 0920-1077
ICR 201506-0920-001
IC 216866
( )
Documents and Forms
Document Name
Document Type
Att H_Employer Follow-Up Survey_4-20-15.docx
Other-WORD Screenshots
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att H_Employer Follow-up Survey
Agency IC Tracking Number:
15OO
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
Other-WORD Screenshots
Att H_Employer Follow-Up Survey_4-20-15.docx
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
120
Number of Respondents for Small Entity:
60
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
120
0
120
0
0
0
Annual IC Time Burden (Hours)
30
0
30
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.