Employer Follow-up Survey

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

OMB: 0920-1006

IC ID: 209579

Information Collection (IC) Details

View Information Collection (IC)

Employer Follow-up Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Employer Follow-up Survey Att E-4_Employer Followup Survey_12-17-15.docx Yes Yes Fillable Fileable

Health Illness Prevention

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

160 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 160 0 -80 0 0 240
Annual IC Time Burden (Hours) 40 0 -20 0 0 60
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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