Occupational Safety and Health Program Evaluation Survey Year 1

Evaluating the Effectiveness of Occupational Safety and Health Program Elements in theWholesale Retail Sector

Documents and Forms

Document Name Document Type
Att H-1_OSH Program Evaluaton Survey Year 1_092315.docx Other-WORD
Att H-2_OSH Program Evaluaton Survey Year 2_092315.docx Other-WORD
BLISS Survery Qualtrics screen shots_092315.docx BLISS (Screenshots) IC Document

Information Collection (IC) Details

IC Title:	Occupational Safety and Health Program Evaluation Survey Year 1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			Att H-1_OSH Program Evaluaton Survey Year 1_092315.docx		Yes	Yes	Fillable Fileable
Other-WORD			Att H-2_OSH Program Evaluaton Survey Year 2_092315.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,404	Number of Respondents for Small Entity: 3,083

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 95 %

	Requested	Previously Approved
Annual Number of Responses for this IC	4,404	4,404
Annual IC Time Burden (Hours)	1,468	1,468
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
BLISS (Screenshots)	BLISS Survery Qualtrics screen shots_092315.docx	09/29/2015

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