Information Collection

OSHA's Conflict of Interest (COI) and Disclosure Form

IC 46139 under ICR 201611-1218-009 · OMB 1218-0255.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0255 can be found here:

Documents and Forms

Document Name Document Type
Form OSHA10-80.1 OSHA's Conflict of Interest (COI) and Disclosure Form Form
OSHA10-80.1 Conflict of Interest Short Form COI_Short_Form_2017.doc Form
OSHA10-80.2 Conflict of Interest Long Form COI_Long_Form_2017 OSHA10-80.2.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	OSHA's Conflict of Interest (COI) and Disclosure Form	Agency IC Tracking Number:	1218-0255(2017)

Is this a Common Form? No		IC Status: Modified

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	OSHA10-80.1	Conflict of Interest Short Form	COI_Short_Form_2017.doc		No		Paper Only
Form	OSHA10-80.2	Conflict of Interest Long Form	COI_Long_Form_2017 OSHA10-80.2.doc		No		Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	36	36
Annual IC Time Burden (Hours)	27	27
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.