Att C_Request for a Health Hazard Evaluation (Employees and Employers)

Health Hazard Evaluations/Technical Assistance and Emerging Problems

OMB: 0920-0260

IC ID: 185718

Information Collection (IC) Details

View Information Collection (IC)

Att C_Request for a Health Hazard Evaluation (Employees and Employers) 0920-0260
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-0260 HHE Request Form Att C_Hlth Haz Eval Req Form - English.pdf Yes Yes Fillable Fileable

Health Illness Prevention

Occupational Health Epidemiological Studies  76 FR 34706

250 135
   
Private Sector Businesses or other for-profits, Farms, Not-for-profit institutions
 
   80 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 250 0 -40 0 0 290
Annual IC Time Burden (Hours) 50 0 -8 0 0 58
Annual IC Cost Burden (Dollars) 1,708 0 -273 0 0 1,981

Title Document Date Uploaded
Att C1_HHE Request Form (Spanish version) Att C1_Hlth Haz Eval Req Form - Spanish.docx 06/02/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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