Information Collection

Supervisor's Preliminary Mishap/Incident Report

IC 239987 under ICR 202308-0701-003 · OMB 0701-0164.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AF 978 Supervisor's Preliminary Mishap/Incident Report	Form
AF 978 Supervisor's Preliminary Mishap/Incident Report 0701-0164_AF Form 978.pdf	Form
AF 978 Supervisor's Preliminary Mishap/Incident Report 0701-0164_AF Form 978.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1960

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	AF 978	Supervisor's Preliminary Mishap/Incident Report	0701-0164_AF Form 978.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	1,450	1,450

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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