Information Collection

Workplace Environment Changes and Safety Questionnaire

IC 243088 under ICR 202008-0704-001 · OMB 0704-0593.

Documents and Forms

Document Name Document Type
WHS-WorkplaceSurvey_Instrument 8.14.2020.docx Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Workplace Environment Changes and Safety Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			WHS-WorkplaceSurvey_Instrument 8.14.2020.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	20	20
Annual IC Cost Burden (Dollars)	646	646

Documents for IC

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.