Stakeholder Needs and Interests Market Survey

CDC Workplace Health Promotion Resource Center

Documents and Forms

Document Name Document Type
Stakeholder Needs and Interests Market Survey Form
Stakeholder Needs and Interests Market Survey Att D-5_Stakeholder Survey Screenshots_8-5-16.docx Form

Information Collection (IC) Details

IC Title:	Stakeholder Needs and Interests Market Survey	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
Form	none	Stakeholder Needs and Interests Market Survey	Att D-5_Stakeholder Survey Screenshots_8-5-16.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 267	Number of Respondents for Small Entity: 214

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	267	267
Annual IC Time Burden (Hours)	89	89
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.