Information Collection

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

IC 6639 under ICR 201407-0920-016 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)	Form
Att 5_SAFV .v8.pdf	Other-Screenshots
Standard Application Form for the Approval of Respirator Att 4_SAFV v.7 (Quality Assurance).pdf	Form
Standard Application Form for the Approval of Respirator Att 6_SAFV v.7 (NEW).pdf	Form
Attachment D.xps Attachment D Quality Assurance	IC Document

IC Title:

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 84

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	None	Standard Application Form for the Approval of Respirators Version 7 (Quality Assurance)	Att 4_SAFV v.7 (Quality Assurance).pdf	Yes	Yes	Fillable Printable
Other-Screenshots			Att 5_SAFV .v8.pdf	Yes	Yes	Fillable Printable
Form	None	Standard Application Form for the Approval of Respirators Version & (NEW)	Att 6_SAFV v.7 (NEW).pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 63

Number of Respondents for Small Entity: 60

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	441	-159	600
Annual IC Time Burden (Hours)	100,989	-36,411	137,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D Quality Assurance	Attachment D.xps	05/12/2011

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