Information Collection

RBCD_Survey

IC 246442 under ICR 202103-0920-009 · OMB 0920-1343.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1343 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-21AN RBCD_Survey	Form and Instruction
0920-21AN RBCD_Survey Attachment 3d.docx	Form and Instruction
0920-21AN RBCD_Survey Attachment 3d.docx	Form and Instruction

IC Title:

RBCD_Survey

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-21AN	RBCD_Survey	Attachment 3d.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	550	550
Annual IC Time Burden (Hours)	138	138
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.