Case Study Verification Interview

Employer Perspectives of an Insurer-Sponsored Wellness Grant

Documents and Forms

Document Name Document Type
Attachment J2 Telephone script for WWGP ACS interviews .docx Instruction
Annual Case Study Attachment K OHBWC WWGP annual case study (SH-30) downloaded .pdf Form

Information Collection (IC) Details

IC Title:	Case Study Verification Interview	Agency IC Tracking Number:

Is this a Common Form? No		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
Instruction			Attachment J2 Telephone script for WWGP ACS interviews .docx		Yes	No	Paper Only
Form	none	Annual Case Study	Attachment K OHBWC WWGP annual case study (SH-30) downloaded .pdf		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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