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 Followback no onsite Year 1
Follow-back without Onsite Evaluation Year 2 Modified 120 30 0 Form none Follow-back no onsite Year 2
Followback for Onsite Evaluations Year 1 Modified 320 80 0 Form none Followback Year 1
Followback for Onsite Evaluations Year 2 Modified 320 80 0 Form none Followback Year 2
Health Hazard Evaluation Request Form for Employees and Employers Modified 320 64 0 Form none HHE Request Form
Health Hazard Evaluation Specific Interview (Example) Modified 3200 800 0 Form none HHE Evaluation Ineview
Health Hazard Evaluation Specific Questionnaire (Example) Modified 3440 1720 0 Form none HHE Evaluation
Initial and Follow-back for Onsite Evaluations Year 1 Modified 320 80 0 Form none HHE Initial and Follow-back
Total burden requested under this ICR: 8160 2874 0  
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