Baseline Survey

Nurse Fatigue-Mitigation Education: Does it Change Nurse Sleep Behavior?

Documents and Forms

Document Name Document Type
Form 0920-22FC Baseline Survey Form and Instruction
0920-22FC Attachment D.Baseline Survey Attachment D.Survey and open_ended q.docx Form and Instruction
0920-22FC Attachment D.Baseline Survey Attachment D.Survey and open_ended q.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Baseline Survey	Agency IC Tracking Number:	0920-22FC

Is this a Common Form? Yes		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
Form and Instruction	0920-22FC	Attachment D.Baseline Survey	Attachment D.Survey and open_ended q.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	19	19
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.