Conflict of Interest and Disclosure Form

OSHA's Conflict of Interest (COI) and Disclosure Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0255 can be found here:

Documents and Forms

Document Name Document Type
Conflict of Interest and Disclosure Form Form and Instruction
Conflict of Interest and Disclosure Form COI_Form_Final_(05-14-10).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Conflict of Interest and Disclosure Form	Agency IC Tracking Number:	1218-0255(2010)

Is this a Common Form? No		IC Status: Modified

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	None	Conflict of Interest and Disclosure Form	COI_Form_Final_(05-14-10).pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	27	27
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.