Information Collection

Medical Examination, Biospecimen Collection, and Exposure Monitoring

IC 207241 under ICR 201303-0920-010 · OMB 0920-0973.

Documents and Forms

Document Name Document Type
Exam and Specimen.docx Other-Examination

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Examination, Biospecimen Collection, and Exposure Monitoring	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
Other-Examination			Exam and Specimen.docx		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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	43	43
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.