Information Collection

CDC Worksite Health Scorecard

IC 210319 under ICR 201402-0920-006 · OMB 0920-1014.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.