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Participant Eligibility Screening Form
Work Organization Risks to Short-haul Truck Drivers’ Health & Safety
OMB: 0920-1345
IC ID: 248533
OMB.report
HHS/CDC
OMB 0920-1345
ICR 202107-0920-008
IC 248533
( )
Documents and Forms
Document Name
Document Type
Form 0920-20BY
Participant Eligibility Screening Form
Form
0920-20BY Comments_AttachmentC_LSHSurvey_April 22 2021
Comments_AttachmentC_LSHSurvey_April 22 2021.docx
Form
0920-20BY Comments_AttachmentC_LSHSurvey_April 22 2021
Comments_AttachmentC_LSHSurvey_April 22 2021.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Participant Eligibility Screening Form
Agency IC Tracking Number:
0920-20BY
Is this a Common Form?
Yes
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
0920-20BY
Comments_AttachmentC_LSHSurvey_April 22 2021
Comments_AttachmentC_LSHSurvey_April 22 2021.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
300
0
300
0
0
0
Annual IC Time Burden (Hours)
25
0
25
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.