Information Collection

Focus Group Testing of Two Health Hazard Evaluation Program Brochures

IC 207589 under ICR 201205-0920-005 · OMB 0920-0940.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

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	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 %

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	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

table that charts IC Documents
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.