Information Collection

Medical Testing

IC 210761 under ICR 201403-0920-006 · OMB 0920-1024.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att N_Medical Testing.docx	Other-WORD
Att G_Results letter for Lung tests.docx Att G_Results letter for Lung tests	IC Document
Att H Results letter for Blood tests.docx Att H Results letter for Blood tests	IC Document

IC Title:

Medical Testing

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			Att N_Medical Testing.docx		No	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: 09-20-0147 Occupational Health Epidemiological Studies and EEOICPA Program Records and WTC Health Program Records, HHS/CDC/NIOSH

FR Citation: 76 FR 34706

Number of Respondents: 95

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	95	95
Annual IC Time Burden (Hours)	158	158
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att G_Results letter for Lung tests	Att G_Results letter for Lung tests.docx	03/11/2014
Att H Results letter for Blood tests	Att H Results letter for Blood tests.docx	03/11/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.