Information Collection

Summary of Estimated Respondent (Employer) Hour and Cost Burden

IC 252436 under ICR 202501-1218-004 · OMB 1218-0280.

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Document Name	Document Type

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IC Title:

Summary of Estimated Respondent (Employer) Hour and Cost Burden

Agency IC Tracking Number:

1218-0280 (2025)

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1908.6(e)(8) 29 CFR 1908.7(b)(l) 29 CFR 1908.6(f)(5)

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: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	353	-315	668
Annual IC Time Burden (Hours)	88	-76	164
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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