OHSN Enrollment Form

Occupational Health Safety Network (OHSN)

Documents and Forms

Document Name Document Type
Att D_OHSN Enrollment Form.docx Other-WORD
Att C_Data User Agreement.docx Att C_Data User Agreement IC Document

Information Collection (IC) Details

IC Title:	OHSN Enrollment Form	Agency IC Tracking Number:	16CQ

Is this a Common Form? No		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			Att D_OHSN Enrollment Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att C_Data User Agreement	Att C_Data User Agreement.docx	03/21/2016

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