Information Collection

Survey to Improve Worker Notification Efforts #3

IC 216450 under ICR 201211-0920-003 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey to Improve Worker Notification Efforts #3	Form
Survey to Improve Worker Notification Efforts - #3 survey #3_hard copy survey-33115.docx	Form
OMB form_survey tools_survey #3.docx Request for Approval	IC Document

IC Title:

Survey to Improve Worker Notification Efforts #3

Agency IC Tracking Number:

15YO

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	none	Survey to Improve Worker Notification Efforts - #3	survey #3_hard copy survey-33115.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	OMB form_survey tools_survey #3.docx	05/06/2015

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