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

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

16AXC

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.