Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Closeout Survey for Onsite visits - Year 1 Modified 244 81 2777 Form none
Closeout without On-site Evaluation Year 1 Modified 98 16 558 Form none
Employee Contact Information Postcard - example Modified 2150 179 6128 Form none
Followback with Onsite Evaluations - Year 2 Modified 244 61 2084 Form none
Followback without Site-visit Evaluation Year 2 Modified 98 25 837 Form none
HHE Specific Interview (Example) Modified 2580 645 22033 Form none
HHE Specific Worker Questionnaire (Example) Modified 3700 1850 63196 Form none
Health Hazard Evaluation Request Form for Employees and Employers Modified 290 58 1981 Form none
Initial Site-visit Followback Survey Year 1 Modified 244 41 1388 Form none
Total burden requested under this ICR: 9648 2956 100982  
To view an IC, click on IC Title