Information Collection

Notice to Examinee--Ongoing Investigations of Employer's Economic Loss or Injury

IC 185475 under ICR 200802-1215-004 · OMB 1215-0170.

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IC Title:

Notice to Examinee--Ongoing Investigations of Employer's Economic Loss or Injury

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 801.12

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42,500

Number of Respondents for Small Entity: 39,950

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	85,000	85,000
Annual IC Time Burden (Hours)	42,500	42,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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