Information Collection

Survey #2

IC 216300 under ICR 201211-0920-003 · OMB 0920-0953.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
survey #2_web survey 3-31-15.docx Other-WORD
Cover letter.docx Instruction
Survey Screen Shots.pdf Other-Screenshots
Request for Approval_Survey #2 docx.docx Request for Approval IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey #2	Agency IC Tracking Number:	15YN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	survey #2_web survey 3-31-15.docx	Yes	Yes	Fillable Printable
Instruction	Cover letter.docx	Yes	Yes	Fillable Fileable
Other-Screenshots	Survey Screen Shots.pdf	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Request for Approval_Survey #2 docx.docx	04/27/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.