Information Collection

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

IC 6639 under ICR 202009-0920-023 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0199 Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators) Form and Instruction
0920-0109 Standard Application Form for Respirator Approval Atch_4_SAF_v9.20190409.pdf Form and Instruction
0920-0109 Standard Application Form for Respirator Approval Atch_4_SAF_v9.20190409.pdf Form and Instruction
0920-0199 Standard Application Form initial Atch_5_SAF_v9.20190409_1.pdf Form and Instruction
0920-0199 Standard Application Form initial Atch_5_SAF_v9.20190409_1.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 84

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0109	Standard Application Form for Respirator Approval	Atch_4_SAF_v9.20190409.pdf	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0199	Standard Application Form initial	Atch_5_SAF_v9.20190409_1.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 140	Number of Respondents for Small Entity: 60

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	560	49	511
Annual IC Time Burden (Hours)	128,240	11,221	117,019
Annual IC Cost Burden (Dollars)	0	0	0

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.