Information Collection

Att 5_Request manufacturing code

IC 263228 under ICR 202311-0920-004 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0109 Att 5_Request manufacturing code	Form and Instruction
0920-0109 NIOSH RESPIRATOR APPROVAL PROGRAM QUESTIONNAIRE FOR POTE Atch_5_Standard Application for the Approval of Respirators (Request Code).docx	Form and Instruction
0920-0109 NIOSH RESPIRATOR APPROVAL PROGRAM QUESTIONNAIRE FOR POTE Atch_5_Standard Application for the Approval of Respirators (Request Code).docx	Form and Instruction

IC Title:

Att 5_Request manufacturing code

Agency IC Tracking Number:

0920-0109

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 84

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	0920-0109	NIOSH RESPIRATOR APPROVAL PROGRAM QUESTIONNAIRE FOR POTENTIAL APPLICANTS	Atch_5_Standard Application for the Approval of Respirators (Request Code).docx	NA	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

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.