Employee Representative Closeout for HHE without Site Visit - Year 2

[NIOSH] Health Hazard Evaluations/Technical Assistance and Emerging Problems

Documents and Forms

Document Name Document Type
Form 0920-0260 Employee Representative Closeout for HHE without Site Visit - Year 2 Form and Instruction
0920-0260 Followback Survey – One Year After Final Letter Attachment L 1 Year Later No HHE Site Visit_Followback Survey Cover Letter and Form.docx Form and Instruction
0920-0260 Followback Survey – One Year After Final Letter Attachment L 1 Year Later No HHE Site Visit_Followback Survey Cover Letter and Form.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Employee Representative Closeout for HHE without Site Visit - Year 2	Agency IC Tracking Number:	0920-0260

Is this a Common Form? No		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 and Instruction	0920-0260	Followback Survey – One Year After Final Letter	Attachment L 1 Year Later No HHE Site Visit_Followback Survey Cover Letter and Form.docx	N/A	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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	94	94
Annual IC Time Burden (Hours)	24	24
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.