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

ICR 201410-0920-013

OMB: 0920-1006

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
 New
Form and Instruction
 New
Justification for No Material/Nonsubstantive Change
2014-10-14
Supplementary Document
2014-10-13
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
213479 New
213472 New
209594 Unchanged
209593 Modified
209592 Removed
209591 Modified
209590 Modified
209589 Modified
209588 Unchanged
209587 Unchanged
209586 Removed
209585 Modified
209584 Unchanged
209583 Modified
209582 Modified
209581 Unchanged
209580 Unchanged
209579 Modified
209578 Modified
209577 Modified
209576 Unchanged
ICR Details
0920-1006 201410-0920-013
Historical Active 201312-0920-004
HHS/CDC 21040
CDC Work@Health Program: Phase 2 Training and Technical Assistance Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/30/2014
Retrieve Notice of Action (NOA) 10/27/2014
  Inventory as of this Action Requested Previously Approved
01/31/2016 01/31/2016 01/31/2016
5,036 0 5,066
1,603 0 1,601
0 0 0
In the following Change Request for 0920-1006, CDC seeks OMB approval to increase the number of participants assigned to the train-the-trainer training model (and associated data collection), and reduce the number of participants assigned to two of the lower-demand employer training models (hands-on and blended) and associated data collections.
US Code: 42 USC 301 Name of Law: Public Health Service Act
   US Code: 42 USC 2801 Name of Law: Employer-based Wellness Program
  
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 5,036 5,066 0 -30 0 0
Annual Time Burden (Hours) 1,603 1,601 0 2 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Change in Burden Hours is the result of a redistribution of respondents that wish to receive a different training option.
$3,515,370
Yes Part B of Supporting Statement
Yes
Yes
No
No
Uncollected
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov
  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.
10/27/2014
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