Information Collection

Acrylonitrile - Medical Surveillance

IC 252908 under ICR 202411-1218-006 · OMB 1218-0126.

Documents and Forms

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Document Name	Document Type

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IC Title:

Acrylonitrile - Medical Surveillance

Agency IC Tracking Number:

1218-0126(2024)

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1910.1045(n)(1)(i) 29 CFR 1910.1045(n)(2) 29 CFR 1910.1045(n)(3)(i) 29 CFR 1910.1045(n)(4)

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

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 104

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 15 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,921	-10,806	14,727
Annual IC Time Burden (Hours)	5,280	-2,147	7,427
Annual IC Cost Burden (Dollars)	0	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.

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