Information Collection

Employees - HHE specific interview example

IC 185718 under ICR 202311-0920-010 · OMB 0920-0260.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0260 Employees - HHE specific interview example	Form and Instruction
0920-0260 HHE - Specific Interview Example Attachment C Interview Example.docx	Form and Instruction
0920-0260 HHE - Specific Interview Example Attachment C Interview Example.docx	Form and Instruction
Att C1_Hlth Haz Eval Req Form - Spanish.docx Att C1_HHE Request Form (Spanish version)	IC Document
Att C1_Hlth Haz Eval Req Form - Spanish.docx Att C1_HHE Request Form (Spanish version)	IC Document

IC Title:

Agency IC Tracking Number:

0920-0260

Is this a Common Form? No

IC Status: Modified

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 and Instruction	0920-0260	HHE - Specific Interview Example	Attachment C Interview Example.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies

FR Citation: 76 FR 34706

Number of Respondents: 1,710

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: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,710	1,460	250
Annual IC Time Burden (Hours)	428	378	50
Annual IC Cost Burden (Dollars)	0	-1,708	1,708

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Att C1_HHE Request Form (Spanish version)	Att C1_Hlth Haz Eval Req Form - Spanish.docx	06/02/2020

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