Health Hazard Evaluation Request Form for Employees and Employers

Health Hazard Evaluations/Technical Assistance and Emerging Problems

OMB: 0920-0260

IC ID: 185718

Information Collection (IC) Details

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Health Hazard Evaluation Request Form for Employees and Employers
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none HHE Request Form Attachment_C.docx Yes Yes Fillable Fileable

Health Illness Prevention

Occupational Health Epidemiological Studies  76 FR 34706

290 135
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   80 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 290 0 -10 0 0 300
Annual IC Time Burden (Hours) 58 0 -2 0 0 60
Annual IC Cost Burden (Dollars) 1,981 0 1,981 0 0 0

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