Information Collection

Contents of a Request for Health Hazard Evaluation -- 42 CFR 85.3-1

IC 6631 under ICR 199808-0920-002 · OMB 0920-0102.

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Information Collection (IC) Details

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IC Title:	Contents of a Request for Health Hazard Evaluation -- 42 CFR 85.3-1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-100	500
Annual IC Time Burden (Hours)	80	-20	100
Annual IC Cost Burden (Dollars)	0	0	0

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