Information Collection

Women who Express Milk at work interview form

IC 225498 under ICR 201701-0990-001 · OMB 0990-0456.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OWH Employee Interview Form 3.2.17.xlsx	Other-form
0990 60day Federal Register, Volume 81 Issue 209 (Friday, October 28, 2016).htm 60-day FRN	IC Document
30-day Federal Register, Volume 82 Issue 24 (Tuesday, February 7, 2017).htm 30-day FRN	IC Document

IC Title:

Agency IC Tracking Number:

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-form			OWH Employee Interview Form 3.2.17.xlsx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	60	60
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
60-day FRN	0990 60day Federal Register, Volume 81 Issue 209 (Friday, October 28, 2016).htm	03/09/2017
30-day FRN	30-day Federal Register, Volume 82 Issue 24 (Tuesday, February 7, 2017).htm	03/09/2017

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