Information Collection

Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D

IC 14151 under ICR 201809-1218-012 · OMB 1218-0195.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0195 can be found here:

Documents and Forms

Document Name Document Type
Form 29 CFR 1915.1001 A Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D Form and Instruction
29 CFR 1915.1001 A Medical Questionnaire Mandatory SIP IV Final Rule - Asbestos in Shipyards Appendix D Public Burden Statement (03.27.19).docx Form and Instruction
asbestos in shipyards appendix d mark-up 03.27.19.pdf appendix d mark-up IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 29 CFR 1915.1001

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	29 CFR 1915.1001 Appendix D	Medical Questionnaire Mandatory	SIP IV Final Rule - Asbestos in Shipyards Appendix D Public Burden Statement (03.27.19).docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 247	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	247	-2,825	3,072
Annual IC Time Burden (Hours)	61	-1,128	1,189
Annual IC Cost Burden (Dollars)	4,849	-38,154	43,003

Documents for IC

Title	Document	Date Uploaded
appendix d mark-up	asbestos in shipyards appendix d mark-up 03.27.19.pdf	03/27/2019

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