Information Collection

Exposure Assessment Questionnaire

IC 206193 under ICR 201303-0920-010 · OMB 0920-0973.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Exposure Assessment Questionnaire	Form
Questionnaire Attachment C-1-questionnaire.docx	Form
Attachment C-2-Exposure factors.docx Exposure Factors	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	Questionnaire	Attachment C-1-questionnaire.docx		Yes	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies and EEOICPA Records

FR Citation: 76 FR 34706

Number of Respondents: 33

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	33	33
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Exposure Factors	Attachment C-2-Exposure factors.docx	02/28/2013

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