Occupational Safety and Health Administration Alliance Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OSHA 12-10.8 Alliance Feedback Questionnaire	Form	New	Available
Form OSHA 12-10.6 Consulate Alliance Template (Other Countries)	Form	New	Available
Form OSHA 12-10.5 Consulate Alliance Template (Mexico)	Form	New	Available
Form OSHA 12-10.4 Regional Alliance Annual Report Template	Form	New	Available
Form OSHA 12-10.3 National Alliance Agreement Template	Form	New	Available
Form OSHA 12-10.7 Biannual Alliance Data Reporting Form	Form	New	Available
Form OSHA 12-10.2b Regional Area Office Alliance Renewal Agreement Template	Form	New	Available
Form OSHA 12-10.2a Regional Area Office Alliance Agreement Template	Form	New	Available
Form OSHA 12-10.1b National Alliance Renewal Agreement Template	Form	New	Available
Form OSHA 12-10.1a National Alliance Agreement Template	Form	New	Available
Form OSHA 12-10.8 Alliance Feedback Questionnaire	Form	New	Available
Form OSHA 12-10.6 Consulate Alliance Template (Other Countries)	Form	New	Available
Form OSHA 12-10.5 Consulate Alliance Template (Mexico)	Form	New	Available
Form OSHA 12-10.4 Regional Alliance Annual Report Template	Form	New	Available
Form OSHA 12-10.3 National Alliance Annual Report Template	Form	New	Available
Form OSHA 12-10.7 Biannual Alliance Data Reporting Form	Form	New	Available
Form OSHA 12-10.2b Regional Area Office Alliance Renewal Agreement Template	Form	New	Available
Form OSHA 12-10.2a Regional Area Office Alliance Agreement Template	Form	New	Available
Form OSHA 12-10.1b National Alliance Renewal Agreement Template	Form	New	Available
Form OSHA 12-10.1a National Alliance Agreement Template	Form	New	Available
60-day Preclearance FRN (2018-06-21).pdf	Supplementary Document	Uploaded 2019-02-04	Available
Alliance Product and Other Project Guidelines (6-28-18).docx	Supplementary Document	Uploaded 2019-02-04	Available
OSHA Act Introduction and Section 2(b)(1).docx	Supplementary Document	Uploaded 2019-02-04	Available
Alliance Program Supporting Statement ROCIS 05.15.19.docx	Supporting Statement A	Uploaded 2019-05-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
234835	OSHA's Alliance Program (Public Sector)	Form	New	Alliance Feedback Questionnaire
234835	OSHA's Alliance Program (Public Sector)	Form	New	Consulate Alliance Template (Other Countries)
234835	OSHA's Alliance Program (Public Sector)	Form	New	Consulate Alliance Template (Mexico)
234835	OSHA's Alliance Program (Public Sector)	Form	New	Regional Alliance Annual Report Template
234835	OSHA's Alliance Program (Public Sector)	Form	New	National Alliance Agreement Template
234835	OSHA's Alliance Program (Public Sector)	Form	New	Biannual Alliance Data Reporting Form
234835	OSHA's Alliance Program (Public Sector)	Form	New	Regional Area Office Alliance Renewal Agreement Template
234835	OSHA's Alliance Program (Public Sector)	Form	New	Regional Area Office Alliance Agreement Template
234835	OSHA's Alliance Program (Public Sector)	Form	New	National Alliance Renewal Agreement Template
234835	OSHA's Alliance Program (Public Sector)	Form	New	National Alliance Agreement Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	Alliance Feedback Questionnaire
234833	OSHA's Alliance Program (Private Sector)	Form	New	Consulate Alliance Template (Other Countries)
234833	OSHA's Alliance Program (Private Sector)	Form	New	Consulate Alliance Template (Mexico)
234833	OSHA's Alliance Program (Private Sector)	Form	New	Regional Alliance Annual Report Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	National Alliance Annual Report Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	Biannual Alliance Data Reporting Form
234833	OSHA's Alliance Program (Private Sector)	Form	New	Regional Area Office Alliance Renewal Agreement Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	Regional Area Office Alliance Agreement Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	National Alliance Renewal Agreement Template
234833	OSHA's Alliance Program (Private Sector)	Form	New	National Alliance Agreement Template

ICR Details

OMB Control No: 1218-0274	ICR Reference No: 201902-1218-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/OSHA	Agency Tracking No: 1218-0NEW
Title: Occupational Safety and Health Administration Alliance Program
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/20/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/16/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2023	36 Months From Approved
Responses	4,993	0	0
Time Burden (Hours)	14,122	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: OSHA's Alliance Program is a structure for working with groups that are committed to worker safety and health. The program enables OSHA to enter into a voluntary cooperative relationship with industry, labor and other groups to improve workplace safety and health, prevent workplace fatalities, injuries and illnesses, and to reach employers and workers that OSHA may not otherwise reach through traditional methods. OSHA collects information from organizations that are signatories to an Alliance agreement through meetings, informal conversations and data forms. OSHA will use the collected information to develop Alliance agreements, support Alliance activities and Alliance agreement objectives, and develop annual and program-wide reports.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 28868	06/21/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 48648	09/16/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
OSHA's Alliance Program (Private Sector)	OSHA 12-10.8, OSHA 12-10.2a, OSHA 12-10.1a, OSHA 12-10.1b, OSHA 12-10.4, OSHA 12-10.2b, OSHA 12-10.7, OSHA 12-10.3, OSHA 12-10.5, OSHA 12-10.6	National Alliance Agreement Template ,   National Alliance Renewal Agreement Template ,   Regional Area Office Alliance Agreement Template ,   Regional Area Office Alliance Renewal Agreement Template ,   Biannual Alliance Data Reporting Form ,   National Alliance Annual Report Template ,   Regional Alliance Annual Report Template ,   Consulate Alliance Template (Mexico) ,   Consulate Alliance Template (Other Countries) ,   Alliance Feedback Questionnaire
OSHA's Alliance Program (Public Sector)	OSHA 12-10.6, OSHA 12-10.2b, OSHA 12-10.8, OSHA 12-10.1b, OSHA 12-10.7, OSHA 12-10.4, OSHA 12-10.5, OSHA 12-10.1a, OSHA 12-10.2a, OSHA 12-10.3	National Alliance Agreement Template ,   National Alliance Renewal Agreement Template ,   Regional Area Office Alliance Agreement Template ,   Regional Area Office Alliance Renewal Agreement Template ,   Biannual Alliance Data Reporting Form ,   National Alliance Agreement Template ,   Regional Alliance Annual Report Template ,   Consulate Alliance Template (Mexico) ,   Consulate Alliance Template (Other Countries) ,   Alliance Feedback Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	4,993	0	0	0	0	4,993
Annual Time Burden (Hours)	14,122	0	0	0	0	14,122
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $338,271

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/16/2019

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