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
Final Followback Report for Site-visits Year 1 Modified 252 63 0 Form none
Followback for Site-visit Evaluations Year 2 Modified 252 63 0 Form none
Followback without Site-visit Evaluation Year 1 Modified 90 15 0 Form none
Followback without Site-visit Evaluation Year 2 Modified 90 23 0 Form none
HHE Specific Interview (Example) Modified 2670 668 0 Form none
HHE Specific Worker Questionnaire (Example) Modified 3800 1900 0 Form none
Health Hazard Evaluation Request Form for Employees and Employers Modified 300 60 0 Form none
Form none
Initial Site-visit Followback Survey Year 1 Modified 252 42 0 Form none
Total burden requested under this ICR: 9931 3019 0  
To view an IC, click on IC Title