OMB control number

CDC Work@Health Program: Phase 2 Training and Technical Assistance Evaluation

OMB 0920-1006 · HHS/CDC.

OMB 0920-1006

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Trainee Technical Assistance Survey	Form
Train-the-Trainer Technical Assistance Survey	Form
Instructor/Coach Group Discussion Guide	Form and Instruction
Wave 2 Trainee Reaction Survey	Form
Train-the-Trainer Reaction Survey	Form
Train-the-Trainer Participant Survey	Form
Train-the-Trainer Application Form	Form
Trainee Focus Group Discussion Guide	Form and Instruction
Case Study Interviews with Selected Trainees	Form and Instruction
Trainee Reaction Survey Blended Model	Form
Trainee Reaction Survey - Online Model	Form
Trainee Reaction Survey- Hands-On Model	Form
Trainee KAB Survey	Form
Case Study Interviews with Employees	Form and Instruction
Case Study Interviews with Senior Leadership	Form and Instruction
Employer Follow-up Survey	Form
Organizational Assessment	Form
CDC Worksite Health Scorecard	Form
Employer Application Form	Form
Work@Health Extension SS_B 12-18-15.doc	Supporting Statement B
Work@Health SS_A 01062016.doc	Supporting Statement A
Att J_Employer Training_FAQ.doc	Supplementary Document
Att D_Data Collection Flowchart_12-14-15.doc	Supplementary Document
Att C_Objective-Survey Instrument Crosswalk.doc	Supplementary Document
Att B-2_Summary of Public Comments.docx	Supplementary Document
Att B-1_60-day FRN 8 04 2015.pdf	Supplementary Document
A-3_PHSA Rsch.pdf	Supplementary Document
A-2_Funding Authority_ACA.pdf	Supplementary Document
A-1_Authorizing Legislation_EBWP.docx	Supplementary Document
Trainee Technical Assistance Survey	Form
Train-the-Trainer Technical Assistance Survey	Form
Instructor/Coach Group Discussion Guide	Form and Instruction
Wave 2 Trainee Reaction Survey	Form
Train-the-Trainer Reaction Survey	Form
Train-the-Trainer Participant Survey	Form
Train-the-Trainer Application Form	Form
Trainee Focus Group Discussion Guide	Form and Instruction
Case Study Interviews with Selected Trainees	Form and Instruction
Trainee Reaction Survey Blended Model	Form
Trainee Reaction Survey - Online Model	Form
Trainee Reaction Survey- Hands-On Model	Form
Trainee KAB Survey	Form
Case Study Interviews with Employees	Form and Instruction
Case Study Interviews with Senior Leadership	Form and Instruction
Employer Follow-up Survey	Form
Organizational Assessment	Form
CDC Worksite Health Scorecard	Form
Employer Application Form	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
201512-0920-008	Revision of a currently approved collection	2016-01-11	Approved without change
201410-0920-013	No material or nonsubstantive change to a currently approved collection	2014-10-27	Approved without change
201312-0920-004	New collection (Request for a new OMB Control Number)	2013-12-05	Approved with change