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Att 11Pre-test Questionnaire for Respirator Fit Testing

IC 263410 under ICR 202410-0920-021 · OMB 0920-0109.

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Att 11Pre-test Questionnaire for Respirator Fit Testing 0920-0109
 
No Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0920-0109 Pre-test Questionnaire for Respirator Fit Testing Atch_11_Health and wellness screening (each test, fit testing).docx Yes Yes Fillable Fileable
Form W-9 Request for Identification Number and Certification Atch_11_ParticipantPaymentInfo.pdf Yes Yes Fillable Fileable Signable

Workforce Management Worker Safety

 

40 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 800 0 0 0 0 800
Annual IC Time Burden (Hours) 80 0 0 0 0 80
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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