View Information Collection (IC)

View Information Collection (IC)

IC Title:	57.202 Healthcare Worker Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	57.202	HealthCare Worker Survey	57.202_HCWPersonnelSurvey_BLANK.ppt		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	0	0	0	-60,000	0	60,000
Annual IC Time Burden (Hours)	0	0	0	-10,000	0	10,000
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
6_HPS_toi	6_HPS_toi.pdf	12/05/2011
2_HPS_intro	2_HPS_intro.pdf	12/05/2011
7_HPS_keyTerms	7_HPS_keyTerms.pdf	12/05/2011
8_HPS_cdcCodes	8_HPS_cdcCodes.pdf	12/05/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.