Information Collection

Interview Script for Small Business Owners

IC 211605 under ICR 201405-0920-008 · OMB 0920-1029.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment E - Interview Probes.docx	Other-Interview Probes
Attachment D - Interview Statement revised 5-2-14.docx Interview Opening Statement	IC Document
Recruitment Script C 8.19.14.docx Recruitment	IC Document

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-Interview Probes			Attachment E - Interview Probes.docx		Yes	No	Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	120	120
Annual IC Time Burden (Hours)	180	180
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Interview Opening Statement	Attachment D - Interview Statement revised 5-2-14.docx	05/14/2014
Recruitment	Recruitment Script C 8.19.14.docx	08/19/2014

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