Information Collection

Non-respondent Questionnaire

IC 246444 under ICR 202201-0920-018 · OMB 0920-1343.

Documents and Forms

Document Name Document Type
Form 0920-21AN Non-respondent Questionnaire Form and Instruction
0920-21AN Non-respondent Questionnaire Attachment 10.docx Form and Instruction
0920-21AN Non-respondent Questionnaire Attachment 10.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Non-respondent Questionnaire	Agency IC Tracking Number:

Is this a Common Form? Yes		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 and Instruction	0920-21AN	Non-respondent Questionnaire	Attachment 10.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 523	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	523	523
Annual IC Time Burden (Hours)	26	26
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.