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Manager Consent and Interview
Assessment of Ill Worker Policies Study
OMB: 0920-1227
IC ID: 228958
OMB.report
HHS/CDC
OMB 0920-1227
ICR 202204-0920-004
IC 228958
( )
Documents and Forms
Document Name
Document Type
Manager Consent and Interview
Form and Instruction
Manager consent and interview
P_Att 3 Manager InfrmdCnsnt Intrvw 201211.docx
Form and Instruction
Manager consent and interview
P_Att 3 Manager InfrmdCnsnt Intrvw 201211.docx
Form and Instruction
0920-1227 Consent to Participate in Human Research Study
P_Att 3a Manager InfrmdCnsnt Intrvw_220328.docx
Form and Instruction
0920-1227 Consent to Participate in Human Research Study
P_Att 3a Manager InfrmdCnsnt Intrvw_220328.docx
Form and Instruction
Att 6 Manager Interview Marking Guide.docx
Interview Marking Guide
IC Document
Att 6 Manager Interview Marking Guide.docx
Interview Marking Guide
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Manager Consent and Interview
Agency IC Tracking Number:
0920-1227-22ED
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
none
Manager consent and interview
P_Att 3 Manager InfrmdCnsnt Intrvw 201211.docx
Yes
No
Paper Only
Form and Instruction
0920-1227
Consent to Participate in Human Research Study
P_Att 3a Manager InfrmdCnsnt Intrvw_220328.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
53
Number of Respondents for Small Entity:
27
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
106
0
0
0
0
106
Annual IC Time Burden (Hours)
35
0
0
0
0
35
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Interview Marking Guide
Att 6 Manager Interview Marking Guide.docx
11/08/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.