Information Collection

1,3-Butadiene (29 CFR 1910.1051) Appendix F

IC 240175 under ICR 202306-1218-001 · OMB 1218-0170.

Documents and Forms

Document Name Document Type
Form 29 CFR 1910.1051 A 1,3-Butadiene (29 CFR 1910.1051) Appendix F Form and Instruction
29 CFR 1910.1051 A APPENDIX F TO § 1910.1051—MEDICAL QUESTIONNAIRES (NON-MA Butadiene Appendix F Public Burden Statement (03.02.20)ntc.docx Form and Instruction
29 CFR 1910.1051 A APPENDIX F TO § 1910.1051—MEDICAL QUESTIONNAIRES (NON-MA Butadiene Appendix F Public Burden Statement (03.02.20)ntc.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	1,3-Butadiene (29 CFR 1910.1051) Appendix F	Agency IC Tracking Number:	1218-0170(2023)

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1910.1051

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 1910.1051 Appendix F	APPENDIX F TO Â§ 1910.1051âMEDICAL QUESTIONNAIRES (NON-MANDATORY))	Butadiene Appendix F Public Burden Statement (03.02.20)ntc.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 5 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	426	0	426
Annual IC Time Burden (Hours)	213	0	213
Annual IC Cost Burden (Dollars)	15,454	627	14,827

Documents for IC

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