Information Collection

Worker Notification of Monitoring Results

IC 45139 under ICR 201712-1910-002 · OMB 1910-5112.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	Worker Notification of Monitoring Results	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 10 CFR 850

Information Collection Instruments:

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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 23	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,853	-1,994	6,847
Annual IC Time Burden (Hours)	973	-397	1,370
Annual IC Cost Burden (Dollars)	34,940	-11,325	46,265

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.