Information Collection

National Worker Well-being Survey

IC 230660 under ICR 201803-0920-006 · OMB 0920-1234.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
National Worker Well-being Survey	Form
National Worker Well-being Survey Att D Worker_WB_Survey_Revised.docx	Form

IC Title:

Agency IC Tracking Number:

0920-17BM

Is this a Common Form? No

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	National Worker Well-being Survey	Att D Worker_WB_Survey_Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,025

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,025	1,025
Annual IC Time Burden (Hours)	342	342
Annual IC Cost Burden (Dollars)	7,937	7,937

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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