Survey to Improve Worker Notification Efforts

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH 2)

⚠️ Notice: This information collection may be referencing outdated material.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 to Improve Worker Notification Efforts Form
Worker Notification Survey survey #1_with cover letter-33115.docx Form
OMB form_survey tools_survey #1.docx Request for Approval IC Document
Cover letter.docx Cover Letter IC Document
Example Post Card.docx Postcard IC Document

Information Collection (IC) Details

IC Title:	Survey to Improve Worker Notification Efforts	Agency IC Tracking Number:	15YM

IC Status: New

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	none	Worker Notification Survey	survey #1_with cover letter-33115.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and 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: 0 %

	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	OMB form_survey tools_survey #1.docx	04/22/2015
Cover Letter	Cover letter.docx	04/22/2015
Postcard	Example Post Card.docx	04/22/2015

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