Information Collection

Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination

IC 263389 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 0920-0109 Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination Form
0920-0109 Pre- and Post-Test Session Participant Questionnaire and Atch_9_Questionnaire.pdf Form
0920-0109 Pre- and Post-Test Session Participant Questionnaire and Atch_9_Questionnaire.pdf Form
Atch_9a_InformedConsentForm.docx Consent Form IC Document
Atch_9a_InformedConsentForm.docx Consent Form IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination	Agency IC Tracking Number:	0920-0109

Is this a Common Form? No		IC Status: New

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
Form	0920-0109	Pre- and Post-Test Session Participant Questionnaire and Examination	Atch_9_Questionnaire.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Consent Form	Atch_9a_InformedConsentForm.docx	11/14/2023

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