71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)

Maritime Illness Database and Reporting System (MIDRS)

OMB: 0920-1260

IC ID: 235078

Information Collection (IC) Details

View Information Collection (IC)

71.21 (c) Recordkeeping – medical records (Documentation of date/time of last symptom and clearance to return to work for food and nonfood employees)
 
No Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Documentation of Last Symptom and Clearance to Return to Work Att5f.Documentation of Last Symptom and Clearance to Return to Work.docx NA Yes Yes Fillable Fileable

Health Public Health Monitoring

 

250 0
   
Private Sector Businesses or other for-profits
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 0 -250 0 250
Annual IC Time Burden (Hours) 0 0 0 -4 0 4
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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