Flavoring workers - Job History Form

Spectrum of Flavoring Chemical-Related Lung Disease

Documents and Forms

Document Name Document Type
Appx J4_Flav_JobHistory.SPAN.docx Other-WORD
Appx J3_Flav_Job History.ENG.docx Other-WORD

Information Collection (IC) Details

IC Title:	Flavoring workers - Job History Form	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-WORD			Appx J4_Flav_JobHistory.SPAN.docx		No	No	Fillable Printable
Other-WORD			Appx J3_Flav_Job History.ENG.docx		No	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: 09-20-0147 Occupatinal Health Epidemiological Studies	FR Citation: 51 FR 42449

Number of Respondents: 56	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	56	56
Annual IC Time Burden (Hours)	7	7
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.