Information Collection

Att 17 Fit Test STP 5_5.1_6

IC 263421 under ICR 202410-0920-021 · OMB 0920-0109.

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
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:

Agency IC Tracking Number:

0920-0109

Is this a Common Form? No

IC Status: Unchanged

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