PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Closeout Evaluation
New
840
210
0
Other-Evaluation
Followback I
New
55
9
0
Other-Survey
Followback II
New
55
14
0
Other-Survey
Health Hazard Evaluation Request Form for Employees and Employers
New
420
84
0
Other-Questionnaire
Health Hazard Evaluation Specific Interview (Example)
New
4200
1050
0
Other-Health Hazard Evaluation Specific (example)
Health Hazard Evaluation Specific Questionnaire (Example)
Modified
4440
2220
0
Other-Questionnaire
Initial Site Visit Survey Form
New
840
210
0
Other-Survey
One Year Later Evaluation
New
840
210
0
Other-Survey
Total burden requested under this ICR:
11690
4007
0
To view an IC, click on IC Title
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The .gov means it's official.
The site is secure.
