Information Collection

Medical Surveillance - Examinations

IC 260942 under ICR 202306-1218-003 · OMB 1218-0184.

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Information Collection (IC) Details

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IC Title:	Medical Surveillance - Examinations	Agency IC Tracking Number:	1218-0184 (2023)

Is this a Common Form? No		IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1910.10150

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	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
Annual Number of Responses for this IC	101	101
Annual IC Time Burden (Hours)	152	152
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.