Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Employee Contact Information Postcard - example New 2225 185 0 Form none Employee Contact Information Postcard
Final Followback Report for Site-visits Year 1 Modified 252 63 0 Form none Final Followback Survey Report for Site-visits
Followback for Site-visit Evaluations Year 2 Modified 252 63 0 Form none Final Followback Survey for Site-visits Year 2
Followback without Site-visit Evaluation Year 1 Modified 90 15 0 Form none Followback without Site-visit Evaluation Year 1
Followback without Site-visit Evaluation Year 2 Modified 90 23 0 Form none Followback without Site-visit Evaluation Year 2
HHE Specific Interview (Example) Modified 2670 668 0 Form none HHE Specific Interview - example
HHE Specific Worker Questionnaire (Example) Modified 3800 1900 0 Form none HHE Specific Worker Questionnaire - example
Health Hazard Evaluation Request Form for Employees and Employers Modified 300 60 0 Form none HHE Request Form for employees and employers
Form none HHE Request form
Initial Site-visit Followback Survey Year 1 Modified 252 42 0 Form none Initial Site-visit Followback Survey
Total burden requested under this ICR: 9931 3019 0  
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