NCEH/ATSDR Wellness Needs Assessment

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0923-0047 can be found here:

Documents and Forms

Document Name Document Type
Form 0923-0047 NCEH/ATSDR Wellness Needs Assessment Form and Instruction
0923-0047 NCEH/ATSDR Wellness Needs Assessment - Screenshot Attachment B2 - NCEH ATSDR Wellness Needs Assessment_screenshots.docx Form and Instruction
Attachment A1 - Needs Assessment Invitation Email.docx Needs Assessment Invitation Email IC Document
Attachment A2 - Needs Assessment Reminder Email.docx Needs Assessment Reminder Email IC Document
RDF_Wellness Needs Assessment_OSSigned.pdf Non-Research Determination IC Document
0923-0047 NCEH ATSDR Wellness Needs Assessment.pdf GenIC Request IC Document

Information Collection (IC) Details

IC Title:	NCEH/ATSDR Wellness Needs Assessment	Agency IC Tracking Number:	0923-0047-18ABD

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	0923-0047	NCEH/ATSDR Wellness Needs Assessment - Screenshot	Attachment B2 - NCEH ATSDR Wellness Needs Assessment_screenshots.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Needs Assessment Invitation Email	Attachment A1 - Needs Assessment Invitation Email.docx	04/13/2018
Needs Assessment Reminder Email	Attachment A2 - Needs Assessment Reminder Email.docx	04/13/2018
Non-Research Determination	RDF_Wellness Needs Assessment_OSSigned.pdf	04/13/2018
GenIC Request	0923-0047 NCEH ATSDR Wellness Needs Assessment.pdf	04/13/2018

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