Information Collection

CDC Worksite Health Scorecard Registration

IC 234913 under ICR 202201-0920-013 · OMB 0920-1014.

Documents and Forms

Document Name Document Type
Form 0920-1014 CDC Worksite Health Scorecard Registration Form and Instruction
0920-1014 CDC Worksite Health Scorecard Registration Attachment_C-1_CDC Worksite Health ScoreCard Registration Screenshots.pdf Form and Instruction
0920-1014 CDC Worksite Health Scorecard Registration Attachment_C-1_CDC Worksite Health ScoreCard Registration Screenshots.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CDC Worksite Health Scorecard Registration	Agency IC Tracking Number:	0920-1014

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	CDC Worksite Health Scorecard Registration	Attachment_C-1_CDC Worksite Health ScoreCard Registration Screenshots.pdf	na	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 800	Number of Respondents for Small Entity: 600

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	Previously Approved
Annual Number of Responses for this IC	800	0	800
Annual IC Time Burden (Hours)	67	0	67
Annual IC Cost Burden (Dollars)	3,905	358	3,547

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.