Customer Survey

Health Hazard Evaluation Program Customer Survey

Documents and Forms

Document Name Document Type
Form no number Customer Survey Form
no number Customer Survey Attachment C-2 Workplace Hlt Haz Survey.doc Form

Information Collection (IC) Details

IC Title:	Customer Survey	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
Form	no number	Customer Survey	Attachment C-2 Workplace Hlt Haz Survey.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,760	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,760	5,760
Annual IC Time Burden (Hours)	1,440	1,440
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.