Organizational Assessment

CDC Work@Health Program: Phase 2 Training and Technical Assistance Evaluation

OMB: 0920-1006

IC ID: 209578

Information Collection (IC) Details

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Organizational Assessment
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Organizational Assessment Att E-3_Organizational Assessment_12-17-15.docx Yes Yes Fillable Fileable

Health Illness Prevention

0920-0136, Epidemiologic Studies and Surveillance of Disease Problems  57 FR 62812

320 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 320 0 -160 0 0 480
Annual IC Time Burden (Hours) 80 0 -40 0 0 120
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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