Information Collection

Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response

IC 244466 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⚠️ Notice: This information collection may be referencing outdated material.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
Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response	Form
Field TA Survey Attachment 1. Field TA survey_updated.pdf	Form
Virtual TA Survey Attachment 2. Virtual TA survey_updated.pdf	Form
Generic_Clearance_Submission_TA Survey WSH COVID response 11.2.20.docx Request for Approval	IC Document
Attachment 3. First email with link to survey_11.12.docx First email with link to survey	IC Document
Attachment 4. Second email with link to survey_11.12.docx Second email with link to survey	IC Document

IC Title:

Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response

Agency IC Tracking Number:

0920-0953-21AZ

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	none	Field TA Survey	Attachment 1. Field TA survey_updated.pdf		Yes	Yes	Fillable Fileable
Form	none	Virtual TA Survey	Attachment 2. Virtual TA survey_updated.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Generic_Clearance_Submission_TA Survey WSH COVID response 11.2.20.docx	11/12/2020
First email with link to survey	Attachment 3. First email with link to survey_11.12.docx	11/12/2020
Second email with link to survey	Attachment 4. Second email with link to survey_11.12.docx	11/12/2020

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