Employer Questionnaire

National Occupational Safety and Health Professional Workforce Assessment: Employer and Education Provider Survey Data Collection

Documents and Forms

Document Name Document Type
Employer Questionnaire Form
Employer Questionnaire Attachment F Employer Questionnaire (Phases I and II).doc Form
Attachment F Employer Questionnaire Attachment F Employer Questionnaire Dec 2 revised.doc Form
Attachment H Follow-up Ltrs for Employers & Providers.doc Follow-up Letter for non-respondents IC Document
Attachment I-1 Employer Phone Follow-up Prompt & Questionnaire (Phases I&II).doc Employer Phone Follow-up IC Document

Information Collection (IC) Details

IC Title:	Employer Questionnaire	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	None	Attachment F Employer Questionnaire	Attachment F Employer Questionnaire Dec 2 revised.doc		Yes	Yes	Fillable Fileable
Form	None	Employer Questionnaire	Attachment F Employer Questionnaire (Phases I and II).doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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	400	400
Annual IC Time Burden (Hours)	213	213
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Follow-up Letter for non-respondents	Attachment H Follow-up Ltrs for Employers & Providers.doc	08/04/2010
Employer Phone Follow-up	Attachment I-1 Employer Phone Follow-up Prompt & Questionnaire (Phases I&II).doc	08/04/2010

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