Information Collection

Medical Surveillance - Post-Exam Acquisition of Physician's Opinion

IC 182441 under ICR 201708-2070-005 · OMB 2070-0072.

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IC Title:

Medical Surveillance - Post-Exam Acquisition of Physician's Opinion

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 40 CFR 763, Subpart G (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,948

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,948	60	2,888
Annual IC Time Burden (Hours)	246	5	241
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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