Information Collection

Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D

IC 14151 under ICR 202508-1218-003 · OMB 1218-0195.

Documents and Forms

Document Name Document Type
Form 29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D Form and Instruction
Form 29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D Form and Instruction
29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards Appendix D Public Burden Statement.docx Form and Instruction
29 CFR Part 1915.1 Medical Questionnaires Mandatory Asbestos in Shipyards Appendix D Public Burden Statement.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Asbestos in Shipyards (29 CFR 1915.1001) -Appendix D	Agency IC Tracking Number:	1218-0195 (2026)

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 Part 1915.1001 Appendix D	Medical Questionnaires Mandatory	Asbestos in Shipyards Appendix D Public Burden Statement.docx		Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 242	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 15 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	189	-10	199
Annual IC Time Burden (Hours)	46	-3	49
Annual IC Cost Burden (Dollars)	28,539	-1,510	30,049

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.

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