Information Collection

Att 17 Fit Test STP 5_5.1_6

IC 263421 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⚠️ Notice: This information collection may be referencing outdated material.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 TEB-1023 Rev.1 Att 17 Fit Test STP 5_5.1_6	Form
TEB-1023 Rev.1 Subject Template (Fit test STP 5_5.1_6) Atch_17_Fit Tests STP-5_5.1_6.docx	Form
TEB-1023 Rev.1 Subject Template (Fit test STP 5_5.1_6) Atch_17_Fit Tests STP-5_5.1_6.docx	Form

IC Title:

Att 17 Fit Test STP 5_5.1_6

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	TEB-1023 Rev.1	Subject Template (Fit test STP 5_5.1_6)	Atch_17_Fit Tests STP-5_5.1_6.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14

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	280	280
Annual IC Time Burden (Hours)	42	42
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.