OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Employer Perspectives of an Insurer-Sponsored Wellness Grant

ICR 201601-0920-005 · OMB 0920-1117 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Wellness Grant_SSA clean.docx Supporting Statement A Uploaded 2016-06-14 Available
Section B WWGP 20160104.docx Supporting Statement B Uploaded 2016-01-07 Available
Attachment M Employer Participation Information sheet 20140610.docx Supplementary Document Uploaded 2016-01-06 Available
Attachment L Information Security Plan 20151210.docx Supplementary Document Uploaded 2016-01-06 Available
Attachment I IRB Renewal 01379_01251_01370_ HSRB 14-DSHEFS-01XP 2015.pdf Supplementary Document Uploaded 2016-01-06 Available
Attachment H Letter of support from OHBWC.docx Supplementary Document Uploaded 2016-01-06 Repair queued
Attachment G NORA FY14 Intramural Funding Opportunity Announcements (JHoward).pdf Supplementary Document Uploaded 2016-01-06 Available
Attachment F OHBWC WWGP Overview and Forms.pdf Supplementary Document Uploaded 2016-01-06 Available
Attachment E - full research project description.docx Supplementary Document Uploaded 2016-01-06 Available
Attachment D OBWC- NIOSH Letter of Agreement 5_04_12.docx Supplementary Document Uploaded 2016-01-06 Available
Attachment C2 CDC-2014-0014-0005 - TWH agenda presentation & Fed Notice.pdf Supplementary Document Uploaded 2016-01-06 Available
Attachment C1 NIOSH Strategic Goals for WWGP proj.docx Supplementary Document Uploaded 2016-01-06 Available
Attachment B 2015-10286 - 60-day Federal Register for WWGP.pdf Supplementary Document Uploaded 2016-01-06 Available
Attachment A Authorizing Legislation (2).docx Supplementary Document Uploaded 2016-01-06 Available
IC Document Collections
IC IDCollectionTypeStatusForm
219521 Case Study Verification Interview Instruction New
219520 Employer Interview for Occupational Health and Safety Specialists Instruction New
219519 Employer Interview for Wellness Program Coordinators Instruction New
ICR Details
0920-1117 201601-0920-005
Historical Active
HHS/CDC 15ADW
Employer Perspectives of an Insurer-Sponsored Wellness Grant
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/14/2016
Retrieve Notice of Action (NOA) 01/14/2016
  Inventory as of this Action Requested Previously Approved
06/30/2017 12 Months From Approved
150 0 0
150 0 0
0 0 0
This ICR is to determine the effectiveness and economic return of grant-supported workplace wellness programs and to understand the impact of integrating of wellness with traditional occupational safety and health programs, including economic analyses to determine costs, savings, and benefits to cost ratios. The collection involves semi-structured in-person interviews and brief phone interviews.
US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  80 FR 25296 05/04/2015
81 FR 1424 01/12/2016
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 150 0 0 150 0 0
Annual Time Burden (Hours) 150 0 0 150 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$20,117
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
01/14/2016