Information Collection

Summary of Estimated Annualized Respondent (State Consultation Program) Hour and Cost Burden

IC 259860 under ICR 202304-1218-003 · OMB 1218-0281.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PSM Evaluation Worksheet.docx	Other-Worksheet
PSM Evaluation Worksheet.docx	Other-Worksheet
Apx E Interim-Year SHARP Self-Eval (CPPM doc).docx	Other-Worksheet
Apx E Interim-Year SHARP Self-Eval (CPPM doc).docx	Other-Worksheet
Apx F-1 SHP Action Plan Template (Apx F - CPPM doc).docx	Other-Worksheet
Apx F-1 SHP Action Plan Template (Apx F - CPPM doc).docx	Other-Worksheet
Apx F-2 Optional SHP Action Plan Tool (Apx F -CPPM doc).docx	Other-Worksheet
Apx F-2 Optional SHP Action Plan Tool (Apx F -CPPM doc).docx	Other-Worksheet
Apx L-2 PSM SHARP Self-Eval.docx	Instruction
Apx L-2 PSM SHARP Self-Eval.docx	Instruction
Apx L-3 Determining Applicability of PSM.docx	Instruction
Apx L-3 Determining Applicability of PSM.docx	Instruction
Apx M Incident Invest Rep Template (CPPM doc).docx	Other-Worksheet
Apx M Incident Invest Rep Template (CPPM doc).docx	Other-Worksheet
Table C-1 Optional PSM Wksht.docx	Other-Worksheet
Table C-1 Optional PSM Wksht.docx	Other-Worksheet
Table C-2 Optional PSM Wksht.docx	Other-Worksheet
Table C-2 Optional PSM Wksht.docx	Other-Worksheet
Table D Optional PSM Wksht.docx	Other-Worksheet
Table D Optional PSM Wksht.docx	Other-Worksheet
Table E Optional PSM Wksht.docx	Other-Worksheet
Table E Optional PSM Wksht.docx	Other-Worksheet
Table M Optional PSM Wksht.docx	Other-Worksheet
Table M Optional PSM Wksht.docx	Other-Worksheet

IC Title:

Agency IC Tracking Number:

1218-0NEW (2023)

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1908 (b)(4)

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Electronic Capability
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Instruction	No	Printable Only
Instruction	No	Printable Only
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable
Other-Worksheet	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 244

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	2,844	2,844
Annual IC Time Burden (Hours)	9,258	9,258
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.

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