Information Collection

Daily Post-Shift Questionnaires

IC 266349 under ICR 202403-0920-015 · OMB 0920-1436.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1436 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-23HM Daily Post-Shift Questionnaires	Form
Form 0920-23HM Daily Post-Shift Questionnaires Daily Post-Shift Questionnaires	Form
Form 0920-23HM Daily Post-Shift Questionnaires_Spanish Daily Post-Shift Questionnaires	Form
0920-23HM Daily Post-Shift Questionnaires Attachment 3e - Questionnaire_PostShift_Fatigue OGE.docx	Form
0920-23HM Daily Post-Shift Questionnaires Attachment 3e - Questionnaire_PostShift_Fatigue OGE.docx	Form
0920-23HM Daily Post-Shift Questionnaires_Spanish Attachment 3f - Questionnaire_PostShift_Fatigue OGE- ES.docx	Form
0920-23HM Daily Post-Shift Questionnaires_Spanish Attachment 3f - Questionnaire_PostShift_Fatigue OGE- ES.docx	Form

IC Title:

Daily Post-Shift Questionnaires

Agency IC Tracking Number:

0920-23HM

Is this a Common Form? Yes

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	0920-23HM				Yes	Yes	Fillable Fileable
Form	0920-23HM				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,120	1,120
Annual IC Time Burden (Hours)	56	56
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.

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