Information Collection

Evaluation of Worker Notification Program Response Card

IC 7019 under ICR 201205-0920-006 · OMB 0920-0566.

Documents and Forms

Document Name Document Type
Form 0920-0566 Evaluation of Worker Notification Program Response Card Form and Instruction
0920-0566 Attachment C Response Card Attach-C (2) .docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of Worker Notification Program Response Card	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0566	Attachment C Response Card	Attach-C (2) .docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,000	8,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

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.