Information Collection

Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)

IC 6639 under ICR 201801-0920-002 · OMB 0920-0109.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0109 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0109 Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators) Form
0920-0109 Standard Application Form for Respirator Approval Att 4 SAF.pdf Form
Attachment D.xps Attachment D Quality Assurance IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Information Collection Provisions in 42 CFR Part 84 - (Standard Application fro the Approval of Resiporators)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 84

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-0109	Standard Application Form for Respirator Approval	Att 4 SAF.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 73	Number of Respondents for Small Entity: 60

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	511	511
Annual IC Time Burden (Hours)	117,019	117,019
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment D Quality Assurance	Attachment D.xps	05/12/2011

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.