Information Collection

Early Exit Interview - Original Data Collection

IC 198869 under ICR 201409-0920-008 · OMB 0920-0907.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Early Exit Interview - Original Data Collection	Form and Instruction
Early Exit Interview Attachment H-5 Early Exit Interview.docx	Form and Instruction
Attachment A Authorizing Legislation.docx Authorizing Legislation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	None	Early Exit Interview	Attachment H-5 Early Exit Interview.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3	-50	53
Annual IC Time Burden (Hours)	1	-3	4
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation	Attachment A Authorizing Legislation.docx	09/10/2014

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