Information Collection

Occupational Safety and Health Program Evaluation Survey Year 1

IC 202831 under ICR 201509-0920-004 · OMB 0920-0949.

Documents and Forms

Documents and forms in this information collection
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

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.