Information Collection

Pesticide Protection Equipment Survey

IC 209185 under ICR 201311-0535-001 · OMB 0535-0253.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form QID Pesticide Protection Equipment Survey	Form and Instruction
QID Pesticide Safety Practices Survey NIOSH_PPE_Questionnaire_V1_110113.docx	Form and Instruction
QID Pesticide Safety Practices Screener NIOSH_PPE_Screening_103113.docx	Form and Instruction
QID Respondent Reference Sheet NIOSH_PPE_Reference_Sheet_V2_110113.docx	Form and Instruction

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	Available Electronically?	Electronic Capability
Form and Instruction	QID	Pesticide Safety Practices Survey	NIOSH_PPE_Questionnaire_V1_110113.docx	No	Paper Only
Form and Instruction	QID	Pesticide Safety Practices Screener	NIOSH_PPE_Screening_103113.docx	No	Paper Only
Form and Instruction	QID	Respondent Reference Sheet	NIOSH_PPE_Reference_Sheet_V2_110113.docx	No	Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title: SORN

FR Citation: 74 FR 79

Number of Respondents: 2,400

Number of Respondents for Small Entity: 2,100

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Farms

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	2,640	2,640
Annual IC Time Burden (Hours)	800	800
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.