Information Collection

Att D16- COVID19- Round 2

IC 248598 under ICR 202110-0920-005 · OMB 0920-1350.

Documents and Forms

Document Name Document Type
Form 0920- Att D16- COVID19- Round 2 Form
0920- COVID- Round2 Att D16- COVID- Round 2.docx Form
0920- COVID- Round2 Att D16- COVID- Round 2.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att D16- COVID19- Round 2	Agency IC Tracking Number:	0920-21CG

Is this a Common Form? No		IC Status: Unchanged

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-	COVID- Round2	Att D16- COVID- Round 2.docx		No		Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 180	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	9	9
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.