Information Collection

Annual Report

IC 6649 under ICR 202401-0920-010 · OMB 0920-0138.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0138 Annual Report	Form and Instruction
0920-0138 Attachment D Annual Report_2024 Attachment D Annual Report_2024.docx	Form and Instruction
0920-0138 Attachment D Annual Report_2024 Attachment D Annual Report_2024.docx	Form and Instruction

IC Title:

Annual Report

Agency IC Tracking Number:

0920-0138

Is this a Common Form? Yes

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	0920-0138	Attachment D Annual Report_2024	Attachment D Annual Report_2024.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34

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	Previously Approved
Annual Number of Responses for this IC	34	0	34
Annual IC Time Burden (Hours)	17	1	16
Annual IC Cost Burden (Dollars)	0	-365	365

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.