Information Collection

Att H1_Eligibility Screening

IC 248580 under ICR 202106-0920-006 · OMB 0920-1350.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1350 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920- Att H1_Eligibility Screening	Form
0920- Eligibility Screening Appendix H1_Eligibility Screening.docx	Form
0920- Eligibility Screening Appendix H1_Eligibility Screening.docx	Form

IC Title:

Att H1_Eligibility Screening

Agency IC Tracking Number:

0920-21CG

Is this a Common Form? No

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	0920-	Eligibility Screening	Appendix H1_Eligibility Screening.docx		No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	17	17
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.