Information Collection

Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D

IC 14151 under ICR 202306-1218-011 · OMB 1218-0195.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0195 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 29 CFR Part 1915.1 Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D	Form and Instruction
29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards Appendix D Public Burden Statement 06.14.2023.docx	Form and Instruction
29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards Appendix D Public Burden Statement 06.14.2023.docx	Form and Instruction

IC Title:

Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D

Agency IC Tracking Number:

1218-0195 (2023)

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 29 CFR 1915.1001

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	29 CFR Part 1915.1001 Appendix D	Medical Questionnaires Mandatory	Asbestos in Shipyards Appendix D Public Burden Statement 06.14.2023.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 255

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	Previously Approved
Annual Number of Responses for this IC	199	-57	256
Annual IC Time Burden (Hours)	49	-14	63
Annual IC Cost Burden (Dollars)	30,049	25,024	5,025

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.