Information Collection

Return to Work Poll (NLM)

IC 253289 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⚠️ Notice: This information collection may be referencing outdated material.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 Return to Work Poll (NLM)	Form
1 2022 Return to Work survey 2022 Return to Work Survey Instrument.pdf	Form
NLM Fast Track ICR Return to Work Poll.docx fast track study Return to Work Poll	IC Document
Return to Work Survey Email.docx email invite	IC Document
NLM Insider Home Page.pdf NLM Insider Home Page	IC Document

IC Title:

Return to Work Poll (NLM)

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	2022 Return to Work survey	2022 Return to Work Survey Instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

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	1,800	1,800
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
fast track study Return to Work Poll	NLM Fast Track ICR Return to Work Poll.docx	05/06/2022
email invite	Return to Work Survey Email.docx	05/06/2022
NLM Insider Home Page	NLM Insider Home Page.pdf	05/06/2022

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