Information Collection

AbsenteeismTracking Form

IC 213909 under ICR 201411-0920-005 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AbsenteeismTracking Form	Form
Monitoring Template Attachment D.xlsx	Form
Attachment E.doc Invitational Email and Consent	IC Document
Attachment F.doc Study Announcement	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
Form	none	Monitoring Template	Attachment D.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 28

Number of Respondents for Small Entity: 7

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	7,280	7,280
Annual IC Time Burden (Hours)	607	607
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Invitational Email and Consent	Attachment E.doc	11/17/2014
Study Announcement	Attachment F.doc	11/17/2014

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