Information Collection

Worker Notification Feedback Survey

IC 232892 under ICR 201802-0920-007 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0953 Worker Notification Feedback Survey	Form and Instruction
0920-0953 Worker Notification Feedback Survey survey_FINAL_08292018.docx	Form and Instruction
IWSB fast track submission 082918.docx Generic Template IWSB	IC Document

IC Title:

Worker Notification Feedback Survey

Agency IC Tracking Number:

0920-0953-18AYL

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
Form and Instruction	0920-0953	Worker Notification Feedback Survey	survey_FINAL_08292018.docx	NA	No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Template IWSB	IWSB fast track submission 082918.docx	08/31/2018

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