Information Collection

Participant Eligibility Screening Form

IC 248533 under ICR 202107-0920-008 · OMB 0920-1345.

Documents and Forms

Document Name Document Type
Form 0920-20BY Participant Eligibility Screening Form Form
0920-20BY Comments_AttachmentC_LSHSurvey_April 22 2021 Comments_AttachmentC_LSHSurvey_April 22 2021.docx Form
0920-20BY Comments_AttachmentC_LSHSurvey_April 22 2021 Comments_AttachmentC_LSHSurvey_April 22 2021.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Participant Eligibility Screening Form	Agency IC Tracking Number:	0920-20BY

Is this a Common Form? Yes		IC Status: New

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
Form	0920-20BY	Comments_AttachmentC_LSHSurvey_April 22 2021	Comments_AttachmentC_LSHSurvey_April 22 2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
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.