Student Data Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Form 182 Student Data Form	Form and Instruction	Modified	Available
60_Day_FRN (1218-0172) (08-23-2013).pdf	Supplementary Document	Uploaded 2013-12-03	Available
SS_1218-0172_(11-05-13) Final.doc	Supporting Statement A	Uploaded 2013-12-03	Available
e-CFR-29 CFR 1949.docx	Supplementary Document	Uploaded 2013-10-31	Available
OSH Act Section 21.docx	Supplementary Document	Uploaded 2013-10-31	Available
Title 31 USC 9701.docx	Supplementary Document	Uploaded 2013-10-31	Available
OMB_circular_A-25.pdf	Supplementary Document	Uploaded 2013-10-31	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
14106	Student Data Form	Form and Instruction	Modified

ICR Details

OMB Control No: 1218-0172	ICR Reference No: 201310-1218-003
Status: Historical Active	Previous ICR Reference No: 201009-1218-001
Agency/Subagency: DOL/OSHA	Agency Tracking No: 1218-0172(2013)
Title: Student Data Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/06/2014
	Date Received in OIRA: 12/23/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	36 Months From Approved	02/28/2014
Responses	3,000	0	2,000
Time Burden (Hours)	240	0	160
Cost Burden (Dollars)	0	0	0

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Abstract: OSHA Form 182 is used to collect student group and emergency contact information from OSHA Training Institute students. The collected information is used to contact a designated person in case of an emergency. Student group data is used for reports, and tuition receipts.

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Authorizing Statute(s): US Code: 29 USC 670 Name of Law: Occupational Safety and Health Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52565	08/23/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 77496	12/23/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Student Data Form	Form 182	Student Data Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,000	2,000	0	0	1,000	0
Annual Time Burden (Hours)	240	160	0	0	80	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Agency is requesting an 80 hour burden adjustment increase (from 160 hours to 240 hours) as a result of increasing the number of students attending the Institute from 2,000 to 3,000 students.

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Annual Cost to Federal Government: $5,643

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/23/2013

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