Interview Script for Small Business Owners

Total Worker Health for Small Business

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Interview Script for Small Business Owners	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	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 %

	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

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.