Request for Course Change (Example)

Pulmonary Function Testing Course Approval Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0138 can be found here:

Documents and Forms

Document Name Document Type
Attachment G NIOSH-Example of e-mail request for course change_2020.docx Other-Example of email request
Attachment G NIOSH-Example of e-mail request for course change_2020.docx Other-Example of email request

Information Collection (IC) Details

IC Title:	Request for Course Change (Example)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Example of email request			Attachment G NIOSH-Example of e-mail request for course change_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: 24	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	24	0	24
Annual IC Time Burden (Hours)	12	0	12
Annual IC Cost Burden (Dollars)	276	12	264

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.