Information Collection

Flavoring workers - Job History Form

IC 207495 under ICR 201306-0920-011 · OMB 0920-0979.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appx J4_Flav_JobHistory.SPAN.docx	Other-WORD
Appx J3_Flav_Job History.ENG.docx	Other-WORD

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.