CDC Workplace Health Promotion Resource Center

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
TA Pilot Assessment	Form	New	Available
TA Feedback Survey	Form	New	Repair queued
Consumer Feedback Survey	Form	New	Available
Stakeholder Needs and Interests Market Survey	Form	New	Available
Att C_Information Collection Summary_8-5-16.doc	Supplementary Document	Uploaded 2016-08-29	Available
Att B-2_Summary of Public Comments_8-5-16.docx	Supplementary Document	Uploaded 2016-08-29	Available
Att B-1_60_Day_FRN_Resource_Center_2016-09638_4-26-16.pdf	Supplementary Document	Uploaded 2016-08-29	Repair queued
A-3_PHSA Rsch.pdf	Supplementary Document	Uploaded 2016-08-29	Available
A-2_Funding Authority_ACA.pdf	Supplementary Document	Uploaded 2016-08-29	Available
A-1_Authorizing Legislation_EBWP.docx	Supplementary Document	Uploaded 2016-08-29	Available
WHP Resource Center SS_B_8-19-16_clean_copy.docx	Supporting Statement B	Uploaded 2016-08-29	Available
WHP Resource Center SS_A_8-19-16_clean_copy.docx	Supporting Statement A	Uploaded 2016-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223226	TA Pilot Assessment	Form	New
223225	TA Feedback Survey	Form	New
223224	Consumer Feedback Survey	Form	New
223223	Stakeholder Needs and Interests Market Survey	Form	New
223222	Research Community Needs and Interests Interview Guide	Other-Interview Guide	New
223221	Journalists Needs and interests Interview Guide	Other-Interview guide	New
223220	Business Groups, Vendors Consultants, PHO Interview Guide	Other-Interview Guide	New
223219	Employer Needs and Interests Interview Guide	Other-Interview Guide	New

ICR Details

OMB Control No: 0920-1151	ICR Reference No: 201608-0920-015
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 16ACN
Title: CDC Workplace Health Promotion Resource Center
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2016
	Date Received in OIRA: 08/31/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved
Responses	764	0	0
Time Burden (Hours)	138	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As part of developing the Resource Center, CDC will conduct formative research to understand the needs and wishes of the target audience (Phase 1). After developing the Resource Center, CDC will assess consumer satisfaction with the IC and TA provided (Phase 2). The resulting data will be used to better tailor the contents, technical support and dissemination practices of the Resource Center to the needs and wishes of the target audience.

---

Authorizing Statute(s): US Code: 42 USC 2801 Name of Law: PHSA
   PL: Pub.L. 111 - 148 4022 Name of Law: ACA
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24615	04/26/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 59629	08/30/2016
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Employer Needs and Interests Interview Guide
Business Groups, Vendors Consultants, PHO Interview Guide
Journalists Needs and interests Interview Guide
Consumer Feedback Survey	none	Consumer Feedback Survey
Research Community Needs and Interests Interview Guide
Stakeholder Needs and Interests Market Survey	none	Stakeholder Needs and Interests Market Survey
TA Feedback Survey	none	TA Feedback Survey
TA Pilot Assessment	none	TA Pilot Assessment

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	764	0	0	764	0	0
Annual Time Burden (Hours)	138	0	0	138	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR.

---

Annual Cost to Federal Government: $135,376

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/31/2016

---