Occupational Safety and Health Administration Conflict of Interest and Disclosure

ICR 201611-1218-009

OMB: 1218-0255

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2017-04-18
Supplementary Document
2017-02-15
Supplementary Document
2016-11-30
IC Document Collections
IC ID
Document
Title
Status
46139 Modified
ICR Details
1218-0255 201611-1218-009
Historical Active 201311-1218-007
DOL/OSHA 1218-0255(2017)
Occupational Safety and Health Administration Conflict of Interest and Disclosure
Extension without change of a currently approved collection   No
Regular
Approved without change 04/18/2017
Retrieve Notice of Action (NOA) 02/24/2017
  Inventory as of this Action Requested Previously Approved
04/30/2020 36 Months From Approved 04/30/2017
36 0 36
27 0 27
0 0 0

The Conflict of Interest and Disclosure form will be used to determine whether or not a conflict of interest exists for a potential peer review panel member.

PL: Pub.L. 106 - 554 515(1) Name of Law: Information Quality Act
  
None

Not associated with rulemaking

  81 FR 67004 09/29/2016
82 FR 11655 02/24/2017
No

1
IC Title Form No. Form Name
OSHA's Conflict of Interest (COI) and Disclosure Form OSHA10-80.1, OSHA10-80.2 Conflict of Interest Short Form ,   Conflict of Interest Long Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 36 36 0 0 0 0
Annual Time Burden (Hours) 27 27 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
No
No
No
Uncollected
Robert Washington 202 693-2259 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
02/24/2017


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