Information Collection

Hardcopy Survey Sections

IC 248535 under ICR 202107-0920-008 · OMB 0920-1345.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 092-20BY Hardcopy Survey Sections	Form
092-20BY AttachmentK_LSH_RespondentScreeningForm AttachmentK_LSH_RespondentScreeningForm_Sept18.docx	Form
092-20BY AttachmentK_LSH_RespondentScreeningForm AttachmentK_LSH_RespondentScreeningForm_Sept18.docx	Form

IC Title:

Agency IC Tracking Number:

0920-20BY

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	092-20BY	AttachmentK_LSH_RespondentScreeningForm	AttachmentK_LSH_RespondentScreeningForm_Sept18.docx		No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 297

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	297	297
Annual IC Time Burden (Hours)	149	149
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.