Health Screening Site Interview Form

National Healthy Worksite Program

OMB: 0920-0965

IC ID: 202676

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Document Name
Document Type
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Information Collection (IC) Details

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Health Screening Site Interview Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Att E-4_HlthScrnSiteIntvForm.pdf No No Paper Only

Health Immunization Management

 

33 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Requested 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 66 0 66 0 0 0
Annual IC Time Burden (Hours) 33 0 33 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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