Information Collection

Medical Surveillance - Examinations

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

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Documents and Forms

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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:

table that charts list of 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 %

table that charts list of burden
	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

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.