Employer Phone Interview Guide

National Healthy Worksite Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0965 can be found here:

Documents and Forms

Document Name Document Type
Att D-2_NHWP_ErPhIntervGude.pdf Other-WORD
Att D-1_ErEligReq.pdf Att D-1_ErEligReq IC Document
Att D-3_NHWP_ErIntervInst.pdf Att D-3_ErIntervInst IC Document

Information Collection (IC) Details

IC Title:	Employer Phone Interview Guide	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
Other-WORD			Att D-2_NHWP_ErPhIntervGude.pdf		No	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 69	Number of Respondents for Small Entity: 21

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	69	69
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att D-1_ErEligReq	Att D-1_ErEligReq.pdf	06/04/2012
Att D-3_ErIntervInst	Att D-3_NHWP_ErIntervInst.pdf	06/04/2012

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