Information Collection

Att C_Oil and Gas Workers Safety and Health Survey 2,3,5 (Hardcopy)

IC 226608 under ICR 201704-0920-010 · OMB 0920-1195.

Documents and Forms

Document Name Document Type
Att C. Survey.docx Other-WORD
Att P. Survey (Spanish).docx Att P_Survey (Spanish) IC Document
Att F. Consent Form.docx Att F_Consent Form IC Document
Att N. Consent Form (Spanish).docx Att N_Consent Form (Spanish) IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att C_Oil and Gas Workers Safety and Health Survey 2,3,5 (Hardcopy)	Agency IC Tracking Number:	16AXC

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 C. Survey.docx		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25	25
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att P_Survey (Spanish)	Att P. Survey (Spanish).docx	04/28/2017
Att F_Consent Form	Att F. Consent Form.docx	04/28/2017
Att N_Consent Form (Spanish)	Att N. Consent Form (Spanish).docx	04/28/2017

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