Information Collection

Att C_Oil and Gas Extraction Workers Survey - Module 4 (Hardcopy)

IC 226611 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 J. Interviewer Questions.docx	Other-WORD
Att L. Interviewer Questions (Spanish).docx Att L_Interview Questions (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
Other-WORD			Att J. Interviewer Questions.docx		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 19

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att L_Interview Questions (Spanish)	Att L. Interviewer Questions (Spanish).docx	04/28/2017

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