Leading Indicators that Improve Workplace Health and Safety

Formative Data Collections for DOL Research

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1290-0043 can be found here:

Documents and Forms

Document Name Document Type
Appendix B Survey Small Med Example.docx Other-Survey Example
Appendix A Master List Survey Questions.docx Other-Master List Survey Questions
SSA Template for Formative Generic_Base.docx Supporting Statement A for Generic Clearance IC Document

Information Collection (IC) Details

IC Title:	Leading Indicators that Improve Workplace Health and Safety	Agency IC Tracking Number:

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
Other-Survey Example			Appendix B Survey Small Med Example.docx		Yes	Yes	Fillable Fileable
Other-Master List Survey Questions			Appendix A Master List Survey Questions.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 516	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	516	516
Annual IC Time Burden (Hours)	253	253
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement A for Generic Clearance	SSA Template for Formative Generic_Base.docx	06/05/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.