HEALTH AND EMPLOYMENT SURVEY

ICR 198308-0960-009

OMB: 0960-0346

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
115358
Migrated
ICR Details
0960-0346 198308-0960-009
Historical Active
SSA
HEALTH AND EMPLOYMENT SURVEY
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/04/1983
Retrieve Notice of Action (NOA) 08/08/1983
  Inventory as of this Action Requested Previously Approved
06/30/1984 06/30/1984
350 0 0
117 0 0
0 0 0

DATA WILL BE GATHERED, COMPILED AND ANALYZED BY THE JOHNS HOPKINS UNIVERSITY FOR USE BY THE COMMISSIONER IN MAKING A DECISION REGARDING THE ALLEGATIONS OF AN UNHEALTHY WORKING ENVIRONMENT IN THE WOODLAWN DRIVE BUILDING AND A HIGHER THAN USUAL INCIDENCE OF CANCER AMONG EMPLOYEES WORKING THERE. THE AFFECTED PUBLIC IS COMPRISED OF FORMER SSA EMPLOYEES.

None
None


No

1
IC Title Form No. Form Name
HEALTH AND EMPLOYMENT SURVEY

  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 350 0 0 350 0 0
Annual Time Burden (Hours) 117 0 0 117 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/08/1983


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