Employer Phone Interview Guide

National Healthy Worksite Program

Documents and Forms

Document Name Document Type
Attachment_D-2_NHWP_Employer_Phone_Interview_Guide.docx Other-null
Attachment_D-3_Employer_Interviewer_Instructions.docx Attachment_D-3_Employer_Interviewer_Instructions IC Document
Attachment_D-1_NHWP Eligibility Requirements.docx Attachment_D-1_NHWP Eligibility Requirements IC Document

Information Collection (IC) Details

IC Title:	Employer Phone Interview Guide	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-null			Attachment_D-2_NHWP_Employer_Phone_Interview_Guide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

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 %

	Approved	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
Attachment_D-3_Employer_Interviewer_Instructions	Attachment_D-3_Employer_Interviewer_Instructions.docx	03/26/2013
Attachment_D-1_NHWP Eligibility Requirements	Attachment_D-1_NHWP Eligibility Requirements.docx	03/26/2013

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