Information Collection

Interviews to solicit feedback on COVID-19 Worker Factsheets

IC 242116 under ICR 201802-0920-007 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20OY Interviews to solicit feedback on COVID-19 Worker Factsheets	Form and Instruction
0920-20OY Fact sheet testing interview instrument factsheet testing interview instrument.docx	Form and Instruction
0920-0953 GenIC COVID-19 Factsheet 12AUG2020.docx Request for Approval	IC Document

IC Title:

Interviews to solicit feedback on COVID-19 Worker Factsheets

Agency IC Tracking Number:

0920-20OY

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20OY	Fact sheet testing interview instrument	factsheet testing interview instrument.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	0920-0953 GenIC COVID-19 Factsheet 12AUG2020.docx	08/12/2020

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