Information Collection

Post-shift questionnaire (acute symptoms focused) Vet Hospital

IC 281131 under ICR 202606-0920-008 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Post Shift Questionnaire (acute symptoms focused) Vet Hospital Post-shift questionnaire (acute symptoms focused) Vet Hospital	Form and Instruction
Post Shift Questionnaire (acute symptoms focused) Vet Ho Att.12-PostShiftSurvey_RepeatVersion_Vet_R2.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

0920-26-0222

Is this a Common Form? No

IC Status: New

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 and Instruction	n/a				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies and EEOICPA Program Records and WTC Health Program Records (SORN Number: 09-20-0147)

FR Citation: 76 FR 34706

Number of Respondents: 33

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	33	33
Annual IC Time Burden (Hours)	3	3
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.

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