Health Screening Site Interview Form

National Healthy Worksite Program

OMB: 0920-0965

IC ID: 202676

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Health Screening Site Interview Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-null Attachment_E-4_NHWP_Health_Screening_Site_Interview_Form.docx Yes Yes Fillable Printable

Health Public Health Monitoring

 

38 13
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   0 %

  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 76 0 76 0 0 0
Annual IC Time Burden (Hours) 38 0 38 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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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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