Information Collection

OHSN Enrollment Form

IC 220705 under ICR 201603-0920-009 · OMB 0920-1144.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

16CQ

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.