Information Collection

Phase II PFD Evaluation Form

IC 184925 under ICR 200805-0920-011 · OMB 0920-0787.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0787 can be found here:

Documents and Forms

Document Name Document Type
Attachment 8 phase 2 form.doc Other-Evaluation

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Phase II PFD Evaluation Form	Agency IC Tracking Number:

Is this a Common Form? No		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
Other-Evaluation			Attachment 8 phase 2 form.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Occupational Health Epidemiological Studies, HHS/CDC/NIOSH	FR Citation: 68 FR 55962

Number of Respondents: 200	Number of Respondents for Small Entity: 200

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	67	67
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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