Pesticide Protection Equipment Survey

Pesticide Protection Equipment

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Pesticide Protection Equipment Survey	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	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 %

	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

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.