Information Collection

Att 18 Fit Test STP -9 and 10

IC 263422 under ICR 202410-0920-021 · OMB 0920-0109.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETB-1028 Rev 5 Att 18 Fit Test STP -9 and 10	Form
Form ETB-1028 Rev 5 Att 18 Fit Test STP -9 and 10	Form
ETB-1028 Rev 5 Fit Testing Report Atch_18_Fit Tests STP-9 and 10.xls	Form
ETB-1028 Rev 5 Fit Testing Report Atch_18_Fit Tests STP-9 and 10.xls	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	ETB-1028 Rev 5	Fit Testing Report	Atch_18_Fit Tests STP-9 and 10.xls		Yes	Yes	Printable Only

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
No associated records found

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