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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NIOSH] : Satisfaction Survey for three-part virtual workshop series on Impact Wellbeing™ Guide
Agency IC Tracking Number:
0920-0963-24DZ
IC Status:
New
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 and Instruction
0920-0953
Getting Started to Impact Wellbeing Virtual Workshop Feedback Form - Survey 1
2. Impact Wellbeing Workshop 1 Survey_3.14.24.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0953
Fostering a Safe, Supportive Work Environment Virtual Workshop Feedback Form - Survey 2
3. Impact Wellbeing Workshop Survey 2_3.14.24.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0953
Building a System Where Healthcare Workers Thrive Virtual Workshop Feedback Form
4. Impact Wellbeing Workshop 3 Survey_3.14.24.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
150
0
150
0
0
0
Annual IC Time Burden (Hours)
39
0
39
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Request for Approval under the “Generic Clearance for Collection of Routine Customer Feedback” (OMB Control Number: 0920-0953)
Impact Wellbeing Virtual Workshop Series Gen IC_3.20.24.docx
03/26/2024
Invitations and Reminder Emails
5_Impact Wellbeing Workshop Series_Survey Emails_3.14.24.docx
03/26/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.