Information Collection

Methylene Chloride (29 CFR 1910.1052)

IC 14121 under ICR 201809-1218-021 · OMB 1218-0179.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0179 can be found here:

Documents and Forms

Document Name Document Type
Form 29 CFR 1910.1053 Methylene Chloride (29 CFR 1910.1052) Form and Instruction
29 CFR 1910.1053 Questionnaire for Methylene Chloride Exposure SIP IV Final Rule - Methylene Chloride Appendix B Public Burden Statement (03.27.19).docx Form and Instruction
meth chloride app b mark-up.pdf Appendix B mark-up IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Methylene Chloride (29 CFR 1910.1052)	Agency IC Tracking Number:	1218-0179(2018)SIPIV

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1910.1052 29 CFR 1915.1052 29 CFR 1926.1052

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 1910.1053	Questionnaire for Methylene Chloride Exposure	SIP IV Final Rule - Methylene Chloride Appendix B 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: 80,571	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	Previously Approved
Annual Number of Responses for this IC	218,652	218,652
Annual IC Time Burden (Hours)	56,276	56,276
Annual IC Cost Burden (Dollars)	18,417,454	18,417,454

Documents for IC

Title	Document	Date Uploaded
Appendix B mark-up	meth chloride app b mark-up.pdf	09/24/2018

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