CDC Worksite Health Scorecard

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1014 can be found here:

Documents and Forms

Document Name Document Type
CDC Worksite Health Scorecard Form
CDC Worksite Health Scorecard Attachment C-2_CDC Worksite Health Scorecard Screenshots_1_22_14.docx Form
Attachment C-1_CDC Worksite Health Scorecard_1_24_14.docx CDC Worksite Health Scorecard - Word IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CDC Worksite Health Scorecard	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
Form	none	CDC Worksite Health Scorecard	Attachment C-2_CDC Worksite Health Scorecard Screenshots_1_22_14.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 450

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
CDC Worksite Health Scorecard - Word	Attachment C-1_CDC Worksite Health Scorecard_1_24_14.docx	02/03/2014

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