Covid-19 Work Hour Controls Exemption Request Form

10 CFR 26, Fitness for Duty Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3150-0146 can be found here:

Documents and Forms

Document Name Document Type
Form Part 26 Work Hour COVID-19 WORK HOUR CONTROLS EXEMPTION REQUEST FORM Form
Part 26 Work Hour COVID-19 WORK HOUR CONTROLS EXEMPTION REQUEST FORM COVID Work Hour Controls Exemption Request Form.pdf Form

Information Collection (IC) Details

IC Title:	COVID-19 WORK HOUR CONTROLS EXEMPTION REQUEST FORM	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 10 CFR 26

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Part 26 Work Hour Controls Exemption Request	COVID-19 WORK HOUR CONTROLS EXEMPTION REQUEST FORM	COVID Work Hour Controls Exemption Request Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Energy

Subfunction: Energy Resource Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	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	Previously Approved
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	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.