Privacy Narrative

Date
10/13/2021

Information Collection Request - Privacy Narrative
CDC Worksite Health ScoreCard

Title: ______________________________________________________________________________________
Jason Lang ([email protected]; 770-488-5597)
Point of Contact: _____________________________________________________________________________

Description
The CDC Worksite Health Scorecard is a tool designed to help employers assess whether they have
implemented evidence-based health promotion interventions or strategies in their worksites. The
assessment contains 151 core yes/no questions with an additional 20 optional demographic questions
divided into 19 modules (risk factors/conditions/demographics) that assess how evidence-based
health promotion strategies are implemented at a worksite. Employers can use this tool to assess how
a comprehensive health promotion and disease prevention program is offered to their employees, to
help identify program gaps, and to prioritize high-impact health promotion strategies to be
incorporated into their programs.
The Privacy Act for this ICR does not apply to the identifiable employer-level information collected in
the CDC Worksite Health Scorecard registration page and CDC Worksite Health Scorecard survey.
The CDC Worksite Health Scorecard survey will collect information to verify employer contact
information and identify an individual(s) responsible for completing the survey. CDC will have access
to the file that links employer representative identifiers such as names and addresses to unique
employer ID codes. This contact information will be used to work with participating employers on
troubleshooting and correcting any account technological issues, send benchmarking reports, and/or
provide technical assistance. Information collection relates to workplace-related activities and is not
personal in nature. No personally identifiable health information is captured in the survey. The
electronic file linking the employer and the identification number will be securely stored. All information
will be password protected and only accessible to program staff. Survey results will only be reported
in aggregate.
Information will be retained as long as the employer account is active to allow trending progress over
time and for benchmarking purposes.
No information collection involves children under 13 years of age.

Does this ICR request any PII?

✔ Yes

No

Business contact information
If yes, describe: _____________________________________

Does this ICR include a form that requires a Privacy Act Statement?
Does this ICR require a PIA?

Yes

✔

No

Yes

✔

No

If yes, does a signed PIA already exist?

✔

C/I/O Approval
Associate Director for Science

Rachel
Kaufmann -S

Digitally signed by Rachel
Kaufmann -S
Date: 2021.10.15
11:48:45 -04'00'

Information Systems Security Officer

Cynthia
Allen -S

Digitally signed by
Cynthia Allen -S
Date: 2021.10.15
12:42:20 -04'00'

Comments:
This ICR is an extension request of an existing OMB approved system. A signed PIA is on file for the
NCCDPHP Platform which includes the Worksite Health Scorecard.

Yes

No