Information Collection

Quarterly Survey

IC 221844 under ICR 201605-0920-003 · OMB 0920-1131.

Documents and Forms

Document Name Document Type
Quarterly Survey Form and Instruction
Web-Based Survey - Quarterly Att E Web Base Survey Updated Survey and Crisis Text Message.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Quarterly Survey	Agency IC Tracking Number:

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	NA	Web-Based Survey - Quarterly	Att E Web Base Survey Updated Survey and Crisis Text Message.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12	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: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	144	144
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.