TA Feedback Survey

CDC Workplace Health Promotion Resource Center

Documents and Forms

Document Name Document Type
TA Feedback Survey Form
TA Feedback Survey Att D-7_TA Feedback Survey Screenshots_8-5-16.docx Form

Information Collection (IC) Details

IC Title:	TA Feedback 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	TA Feedback Survey	Att D-7_TA Feedback 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: 33	Number of Respondents for Small Entity: 26

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	165	165
Annual IC Time Burden (Hours)	14	14
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.