View Information Collection (IC)

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 and Instruction	0920-0109	Standard Application for the Approval of Respirators (version 7)	Attachment C Standard Application for Resiporator approval.xps		Yes	Yes	Printable Only
Form and Instruction	0920-0109	Attachment E: Standard Application for Respirator Approvale (version 8)	Application Form (Version 8).xps		Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	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 New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	600	0	0	256	0	344
Annual IC Time Burden (Hours)	137,400	0	0	58,624	0	78,776
Annual IC Cost Burden (Dollars)	0	0	0	0	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.