Information Collection

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

IC 6639 under ICR 201105-0920-012 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0109 Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)	Form and Instruction
0920-0109 Standard Application for the Approval of Respirators (ve Attachment C Standard Application for Resiporator approval.xps	Form and Instruction
0920-0109 Attachment E: Standard Application for Respirator Approv Application Form (Version 8).xps	Form and Instruction
Attachment D.xps Attachment D Quality Assurance	IC Document

IC Title:

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 84

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
Form and Instruction	0920-0109	Standard Application for the Approval of Respirators (version 7)	Attachment C Standard Application for Resiporator approval.xps		Yes	Yes	Printable Only
Form and Instruction	0920-0109	Attachment E: Standard Application for Respirator Approvale (version 8)	Application Form (Version 8).xps		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	600	256	344
Annual IC Time Burden (Hours)	137,400	58,624	78,776
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D Quality Assurance	Attachment D.xps	05/12/2011

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