Information Collection

Asbestos in General Industry (29 CFR 1910.1001) Appendix D

IC 240122 under ICR 202509-1218-001 · OMB 1218-0133.

Documents and Forms

Document Name Document Type
Form 29 CFR 1910.1001 A Medical Questionnaires; Mandatory Asbestos in General Industry (29 CFR 1910.1001) Appendix D Form and Instruction
29 CFR 1910.1001 A Medical Questionnaires; Mandatory Asbestos in General Industry Appendix D Public Burden Statement 02.19.2020.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Asbestos in General Industry (29 CFR 1910.1001) Appendix D	Agency IC Tracking Number:	1218-0133 (2026)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1910.1001

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	29 CFR 1910.1001 Appendix D	Medical Questionnaires; Mandatory	Asbestos in General Industry Appendix D Public Burden Statement 02.19.2020.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 121	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 15 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,664	-3,173	4,837
Annual IC Time Burden (Hours)	706	-424	1,130
Annual IC Cost Burden (Dollars)	295,609	-531,518	827,127

Documents for IC

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.

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