Information Collection

CSA_Survey

IC 246443 under ICR 202201-0920-018 · OMB 0920-1343.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-21AN CSA_Survey	Form and Instruction
Form 0920-21AN CSA_Survey CSA_Survey	Form and Instruction
0920-21AN CSA_Survey Attachment 3e.docx	Form and Instruction
0920-21AN CSA_Survey Attachment 3e.docx	Form and Instruction

IC Title:

CSA_Survey

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Unchanged

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 and Instruction	0920-21AN				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	200	200
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.

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