CDC Worksite Health Scorecard- Registration Application

CDC Worksite Health Scorecard

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1014 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1014 CDC Worksite Health Scorecard- Registration Application Form and Instruction
0920-1014 Attachment C-1_CDC Worksite Health Scorecard Registratio Attachment C-1_CDC Worksite Health Scorecard Registration Screenshots_6.26.17.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CDC Worksite Health Scorecard- Registration Application	Agency IC Tracking Number:	14BE

Is this a Common Form? No		IC Status: Modified

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 and Instruction	0920-1014	Attachment C-1_CDC Worksite Health Scorecard Registration Screenshots_6.26.17	Attachment C-1_CDC Worksite Health Scorecard Registration Screenshots_6.26.17.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: The applicable SORN is 0920-0136, Epidemiologic Studies and Surveillance of Disease Problems.	FR Citation: 57 FR 62812

Number of Respondents: 200	Number of Respondents for Small Entity: 200

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	7	7
Annual IC Cost Burden (Dollars)	242	242

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.