OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

CDC Work@Health Advance Program: Evaluation of Train-the-Trainer and Advanced Technical Assistance Program

ICR 201506-0920-001 · OMB 0920-1077 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Work@Health Advance SS B_073015.doc Supporting Statement B Uploaded 2015-08-03 Available
Work@Health Advance SS A_073015.doc Supporting Statement A Uploaded 2015-08-03 Available
Att D_Information Collection Flowchart_4-20-15.docx Supplementary Document Uploaded 2015-06-04 Repair queued
Att C_Program Objective - Survey Instrument Crosswalk_4-20-15.doc Supplementary Document Uploaded 2015-06-04 Available
Att B-2_Summary of Public Comments_4-3-15.docx Supplementary Document Uploaded 2015-06-04 Available
Att B-1_0920-15OO 60-day FRN 2 18 2015.pdf Supplementary Document Uploaded 2015-06-04 Available
Att A-3_PHSA Rsch_FINAL_1-3-14.pdf Supplementary Document Uploaded 2015-06-04 Available
Att A-2_Funding Authority_ACA-FINAL_1-3-14.pdf Supplementary Document Uploaded 2015-06-04 Available
Att A-1_Authorizing Legislation_EBWP_FINAL_1-3-14.docx Supplementary Document Uploaded 2015-06-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
216868 Att J_Train-the-Trainer Knowledge and Skills Survey Other-WORD Screenshots New
216867 Att I_Train-the-Trainer Application Form Other-WORD Screenshots New
216866 Att H_Employer Follow-up Survey Other-WORD Screenshots New
216865 Att G_Follow-up Accreditation Survey Other-WORD Screenshots New
216864 Att F_Advance Evaluataion Other-WORD Screenshots New
216862 Att E_Accrediation Readiness Assessment Tool Other-WORD/Screenshots New
ICR Details
0920-1077 201506-0920-001
Historical Active
HHS/CDC 15OO
CDC Work@Health Advance Program: Evaluation of Train-the-Trainer and Advanced Technical Assistance Program
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 08/03/2015
Retrieve Notice of Action (NOA) 06/11/2015
  Inventory as of this Action Requested Previously Approved
08/31/2018 36 Months From Approved
1,120 0 0
450 0 0
0 0 0
CDC established the Work@Health program to raise employer knowledge and skills related to workplace health programs. The Advance Program builds on previous efforts. Over 3 years, 360 employers will receive advanced technical assistance to help prepare for accreditation of their workplace health programs. In addition, 300 individuals will participate in a train-the-trainer experience to promote program dissemination. Information will be collected from participants for program implementation and improvement.
PL: Pub.L. 111 - 148 4002 Name of Law: Prevention and Public Health Fund
  
None
Not associated with rulemaking
  80 FR 8657 02/18/2015
80 FR 31376 06/02/2015
Yes
  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 1,120 0 0 1,120 0 0
Annual Time Burden (Hours) 450 0 0 450 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a New collection request for a new OMB Control Number
$1,234,300
Yes Part B of Supporting Statement
No
No
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.
06/11/2015