CDC Worksite Health Scorecard

OMB 0920-1014

CDC will continue to provide for the ongoing usage of an updated version of the CDC Worksite Health Scorecard, web-based organizational assessment, by the employer community. The resulting data will be used to support research and increase understanding of the organizational programs, policies, and practices that employers of various sizes and industry sectors have implemented to support health lifestyle behaviors. It will also document changes in organizational practices over time and allow CDC to provide better technical assistance to employers seeking guidance on building or maintaining workplace health promotion programs.

The latest form for CDC Worksite Health Scorecard expires 2022-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1014 CDC Worksite Health Scorecard Form and Instruction
Form 0920-1014 CDC Worksite Health Scorecard Registration Form and Instruction
Attachment_E_CDC Worksite Health ScoreCard Non-Research Determination.pdf Supplementary Document
CDC_ScoreCard_0920-1014_privacy-narrative-signed.pdf Supplementary Document
Attachment_D_CDC Worksite Health ScoreCard FAQs.docx Supplementary Document
Attachment_C-4_CDC_ScoreCard_Resources for Action_updated_12-2021.pdf Supplementary Document
Attachment_C-3_CDC ScoreCard_Sample Benchmarking Report.pdf Supplementary Document
Attachment_B-1_60_Day_FRN_2021-20847.pdf Supplementary Document
Attachment_A-2_Funding Authority ACA PPHF.pdf Supplementary Document
Attachment_A-1_Authorizing Legislation.docx Supplementary Document
CDC Worksite Health ScoreCard SS_A_1-14-22_final.docx Supporting Statement A
CDC Worksite Health ScoreCard SS_B_1-4-22.docx Supporting Statement B
CDC Worksite Health Scorecard Form and Instruction
CDC Worksite Health Scorecard Registration Form and Instruction

All Historical Document Collections

202201-0920-013 Approved without change	Extension without change of a currently approved collection	2022-02-07
201901-0920-009 Approved without change	Revision of a currently approved collection	2019-02-21
201709-0920-008 Approved without change	Reinstatement with change of a previously approved collection	2017-11-21
201402-0920-006 Approved with change	New collection (Request for a new OMB Control Number)	2014-02-10

OMB Details

CDC Worksite Health Scorecard- Registration Application

Federal Enterprise Architecture: Health - Consumer Health and Safety

Form 0920-1014

Attachment C-1_CDC Worksite Health Scorecard Registration Screenshots_6.26.17

Fillable Printable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.