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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.