Information Collection

Assessing Adoption and Use of Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace

IC 204537 under ICR 201008-0920-003 · OMB 0920-0864.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assessing Adoption and Use of Steps to Wellness: A Guide to Implementing the 2008 Physical Activity Guidelines for Americans in the Workplace	Form
Att 2 - Survey 1 Attachment 2_StepsToWellness_Survey1.pdf	Form
Att 4 - Survey 2 Attachment 4_StepsToWellness_Survey2.pdf	Form
Attachment 1_StepsToWellness_website_screenshot.pdf Att 1- Webpage to access toolkit	IC Document
Attachment 3_Follow-up email.doc Att 3 - Email reminder	IC Document
0920-0864_GenIC 8_SS Part B_10 17 2012.doc Supporting Statement B	IC Document
0920-0864_GenIC 8_SS Part A_10 18 2012.doc Supporting Statement A	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Att 2 - Survey 1	Attachment 2_StepsToWellness_Survey1.pdf		Yes	Yes	Fillable Fileable
Form	none	Att 4 - Survey 2	Attachment 4_StepsToWellness_Survey2.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	1,100	0	0	0	0	0
Annual IC Time Burden (Hours)	58	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att 1- Webpage to access toolkit	Attachment 1_StepsToWellness_website_screenshot.pdf	10/18/2012
Att 3 - Email reminder	Attachment 3_Follow-up email.doc	10/18/2012
Supporting Statement B	0920-0864_GenIC 8_SS Part B_10 17 2012.doc	10/18/2012
Supporting Statement A	0920-0864_GenIC 8_SS Part A_10 18 2012.doc	10/18/2012

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