Information Collection

Trans-ORS Return to Work Survey (OD)

IC 252981 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Trans-ORS Return to Work Survey (OD)	Form
1 Return to Work screenshot Trans-ORS Return to Work Survey Screenshots 4-19-2022.docx	Form
Trans-ORS Return to Work Survey PRA Request for Approval.docx fast track for Return to Work Survey	IC Document
Trans-ORS Return to Work Survey_additional doc.docx instructions/invite	IC Document

IC Title:

Trans-ORS Return to Work Survey (OD)

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

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	1	Return to Work screenshot	Trans-ORS Return to Work Survey Screenshots 4-19-2022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	208	208
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track for Return to Work Survey	Trans-ORS Return to Work Survey PRA Request for Approval.docx	04/19/2022
instructions/invite	Trans-ORS Return to Work Survey_additional doc.docx	04/19/2022

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