Information Collection

Followback for Without Onsite Evaluations

IC 283151 under ICR 202610-0920-015 · OMB 0920-0260.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0260 Attachment J No Site Visit_Followback Survey Form Followback for Without Onsite Evaluations	Form
Form 0920-0260 Attachment K No Site Visit_ 1 Year After Final Letter Survey Form Followback for Without Onsite Evaluations	Form
0920-0260 Attachment J No Site Visit_Followback Survey Form Attachment J No Site Visit_Followback Survey Form.docx	Form
0920-0260 Attachment K No Site Visit_ 1 Year After Final Letter Su Attachment K No Site Visit_ 1 Year After Final Letter Survey Form.docx	Form

IC Title:

Agency IC Tracking Number:

0920-26-0227

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	0920-0260				Yes	Yes	Fillable Fileable
Form	0920-0260				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies

FR Citation: 76 FR 34706

Number of Respondents: 94

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: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	188	48	140
Annual IC Time Burden (Hours)	40	-65	105
Annual IC Cost Burden (Dollars)	0	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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