Information Collection

Interview Protocol

IC 231054 under ICR 201804-0920-008 · OMB 0920-1228.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att F - Interview Protocol.docx	Other-Interview protocol
Att I - Informed Consent Script.docx Consent	IC Document

IC Title:

Interview Protocol

Agency IC Tracking Number:

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
Other-Interview protocol					No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	250	250
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	1,190	1,190

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Consent		04/12/2018

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

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