Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Follow-back without Onsite Evaluation Year 1 Modified 120 20 0 Form none
Follow-back without Onsite Evaluation Year 2 Modified 120 30 0 Form none
Followback for Onsite Evaluations Year 1 Modified 320 80 0 Form none
Followback for Onsite Evaluations Year 2 Modified 320 80 0 Form none
Health Hazard Evaluation Request Form for Employees and Employers Modified 320 64 0 Form none
Health Hazard Evaluation Specific Interview (Example) Modified 3200 800 0 Form none
Health Hazard Evaluation Specific Questionnaire (Example) Modified 3440 1720 0 Form none
Initial and Follow-back for Onsite Evaluations Year 1 Modified 320 80 0 Form none
Total burden requested under this ICR: 8160 2874 0  
To view an IC, click on IC Title