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

Document Name
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All Historical Document Collections

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