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Quench Your Thirst Challenge Log
National Healthy Worksite Program
OMB: 0920-0965
IC ID: 202690
OMB.report
HHS/CDC
OMB 0920-0965
ICR 201303-0920-012
IC 202690
( )
Documents and Forms
Document Name
Document Type
Attachment_F-5_Wellness_Challenge_Logs (partial).docx
Other-null
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Quench Your Thirst Challenge Log
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_F-5_Wellness_Challenge_Logs (partial).docx
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,285
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
2,285
0
2,285
0
0
0
Annual IC Time Burden (Hours)
1,143
0
1,143
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
