Information Collection

Baseline Survey

IC 254264 under ICR 202206-0920-011 · OMB 0920-1367.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1367 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

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	0920-22FC	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 %

table that charts list of burden
	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

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.