OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201312-0920-004 · OMB 0920-1006 · Historical Active

Forms and Documents
Document
Name
Status
Supporting Statement B
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supplementary Document
2013-12-02
Supporting Statement A
2013-12-02
IC Document Collections
IC ID
Document
Title
Status
209594 New
209593 New
209592 New
209591 New
209590 New
209589 New
209588 New
209587 New
209586 New
209585 New
209584 New
209583 New
209582 New
209581 New
209580 New
209579 New
209578 New
209577 New
209576 New
ICR Details
0920-1006 201312-0920-004
Historical Active
HHS/CDC 21040
CDC Work@Health Program: Phase 2 Training and Technical Assistance Evaluation
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/02/2014
Retrieve Notice of Action (NOA) 12/05/2013
  Inventory as of this Action Requested Previously Approved
01/31/2016 24 Months From Approved
5,066 0 0
1,601 0 0
0 0 0
This is a new ICR. CDC plans to implement and evaluate a comprehensive workplace health training program called Work@Health. Information will be collected from employers, employees, and trainers.
US Code: 42 USC 2801 Name of Law: Employer-based Wellness Program
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  78 FR 44564 07/24/2013
78 FR 71615 11/29/2013
No
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 5,066 0 0 5,066 0 0
Annual Time Burden (Hours) 1,601 0 0 1,601 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection request. Information collection instruments and other materials were developed and tested in a Phase 1 data collection during Fall 2013 (0920-0989, exp. 9/30/2014).
$3,515,370
Yes Part B of Supporting Statement
Yes
Yes
No
No
Uncollected
Thelma Sims 4046394771
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/05/2013