HHE Specific Worker Questionnaire (Example)

Health Hazard Evaluations/Technical Assistance and Emerging Problems

OMB: 0920-0260

IC ID: 37747

Information Collection (IC) Details

View Information Collection (IC)

HHE Specific Worker Questionnaire (Example)
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none HHE Specific Worker Questionnaire - example Attachment F_Sample HHE Specific Worker Questionnaire.docx No   Fillable Printable

Health Public Health Monitoring

Occupational Health Epidemiological Studies  76 FR 34706

3,800 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 3,800 0 360 0 0 3,440
Annual IC Time Burden (Hours) 1,900 0 180 0 0 1,720
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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