Information Collection

Appx I_ Pre-Test Questionnaire (M/FF/CW)

IC 243405 under ICR 202310-0920-010 · OMB 0920-1331.

Documents and Forms

Document Name Document Type
Appendix I Pre-test screening.docx Other-App (WORD)
Appendix I Pre-test screening.docx Other-App (WORD)

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Appx I_ Pre-Test Questionnaire (M/FF/CW)	Agency IC Tracking Number:	0920-20HO

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-App (WORD)			Appendix I Pre-test screening.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.