World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey Form and Instruction
World Trade Center Health Program Member Questionnaire - Attachment A- paper survey.docx Form and Instruction
World Trade Center Health Program Member Questionnaire - GRCV1TelephoneScriptOMBrevised.docx Form and Instruction
App-GRCOutreachSurvey.doc GenIC Request IC Document

Information Collection (IC) Details

IC Title:	World Trade Center (WTC) Health Program General Responder Consortium (GRC) Outreach Survey	Agency IC Tracking Number:	16JG

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 and Instruction	NA	World Trade Center Health Program Member Questionnaire - Telephone Survey	GRCV1TelephoneScriptOMBrevised.docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	NA	World Trade Center Health Program Member Questionnaire - Paper Survey	Attachment A- paper survey.docx	NA	No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,319	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,319	1,319
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Request	App-GRCOutreachSurvey.doc	01/08/2016

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