Information Collection

Respirable Crystalline Silica Standards for General Industry (29 CFR 1910.1053), Maritime (29 CFR 1915.1053) and Construction (29 CFR 1926.1153) - Sample Forms in Appendix B of the CFR

IC 239109 under ICR 202304-1218-002 · OMB 1218-0266.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0266 can be found here:

Documents and Forms

Document Name Document Type
Form 29 CFR 1910.1053 a Respirable Crystalline Silica Standards for General Industry (29 CFR 1910.1053), Maritime (29 CFR 1915.1053) and Construction (29 CFR 1926.1153) - Sample Forms in Appendix B of the CFR Form
29 CFR 1910.1053 a Written Medical Report for Employee Sample Form Silica Appendix B Sample Form WRITTEN MEDICAL REPORT FOR EMPLOYEE 12-30-19.docx Form
29 CFR 1910.1053 a Written Medical Report for Employee Sample Form Silica Appendix B Sample Form WRITTEN MEDICAL REPORT FOR EMPLOYEE 12-30-19.docx Form
29 CFR 1910.1053 a Written Medical Opinion for Employer Sample Form Silica Appendix B Sample Form WRITTEN MEDICAL OPINION for EMPLOYER 12-30-19.docx Form
29 CFR 1910.1053 a Written Medical Opinion for Employer Sample Form Silica Appendix B Sample Form WRITTEN MEDICAL OPINION for EMPLOYER 12-30-19.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Respirable Crystalline Silica Standards for General Industry (29 CFR 1910.1053), Maritime (29 CFR 1915.1053) and Construction (29 CFR 1926.1153) - Sample Forms in Appendix B of the CFR	Agency IC Tracking Number:	1218-0266(2023)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1915.1053 29 CFR 1910.1053 29 CFR 1926.1153

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	29 CFR 1910.1053 and 29 CFR 1153 Appendix B	Written Medical Report for Employee Sample Form	Silica Appendix B Sample Form WRITTEN MEDICAL REPORT FOR EMPLOYEE 12-30-19.docx		Yes	No	Printable Only
Form	29 CFR 1910.1053 and 29 CFR 1926.1153 Appendix B	Written Medical Opinion for Employer Sample Form	Silica Appendix B Sample Form WRITTEN MEDICAL OPINION for EMPLOYER 12-30-19.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 764,318	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	917,688	-289,479	1,207,167
Annual IC Time Burden (Hours)	229,425	-72,368	301,793
Annual IC Cost Burden (Dollars)	0	-28,892,964	28,892,964

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.