User Feedback Questionnaire for ERHMS Info Manager

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Questionnaire for User Demonstration.docx Other-WORD
OMB Approval for ERHMS Info Manager Feedback Questionnaire.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	User Feedback Questionnaire for ERHMS Info Manager	Agency IC Tracking Number:	16ASP

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-WORD			Questionnaire for User Demonstration.docx		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	OMB Approval for ERHMS Info Manager Feedback Questionnaire.docx	06/24/2016

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