Information Collection

Voluntary Protection Program, Special Government Employee

IC 14302 under ICR 201711-1218-002 · OMB 1218-0239.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0239 can be found here:

Documents and Forms

Document Name Document Type
VPP Application Instructions SITE-BASED Final (2).doc www.osha.gov/dcsp/vpp/application_sitebased.html Instruction
VPP participant self evaluation (2).doc www.osha.gov/dcsp/vpp/2014_format.html Instruction
SGE OF-612.pdf www.osha.gov/dcsp/vpp/sge.htm Instruction
SGE Application Screen Fillable rev 10-11.doc www.osha.gov/dcsp/vpp/sge.html Instruction
PSM Supplement A.final.doc Instruction
PSM Supplement B Evaluation Team Worksheet.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Voluntary Protection Program, Special Government Employee	Agency IC Tracking Number:	1218-0239(2017)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	VPP Application Instructions SITE-BASED Final (2).doc	https://www.osha.gov/dcsp/vpp/application_sitebased.html	Yes	Yes	Fillable Fileable
Instruction	VPP participant self evaluation (2).doc	https://www.osha.gov/dcsp/vpp/2014_format.html	Yes	Yes	Printable Only
Instruction	SGE OF-612.pdf	https://www.osha.gov/dcsp/vpp/sge.htm	Yes	Yes	Fillable Printable
Instruction	SGE Application Screen Fillable rev 10-11.doc	https://www.osha.gov/dcsp/vpp/sge.html	Yes	Yes	Fillable Printable
Instruction	PSM Supplement A.final.doc		No		Paper Only
Instruction	PSM Supplement B Evaluation Team Worksheet.doc		No		Paper Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,274	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,635	-180	3,815
Annual IC Time Burden (Hours)	87,718	-26,432	114,150
Annual IC Cost Burden (Dollars)	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.