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 Survey with Onsite Visit - year 1
Closeout without On-site Evaluation Year 1 Modified 98 16 558 Form none Closeout without onsite Evaluation - year 1
Employee Contact Information Postcard - example Modified 2150 179 6128 Form none Employee Contact Information Postcard - example
Followback with Onsite Evaluations - Year 2 Modified 244 61 2084 Form none Followback for Onsite Evaluation - year 2
Followback without Site-visit Evaluation Year 2 Modified 98 25 837 Form none Followback without Onsite Evaluation - year 1
HHE Specific Interview (Example) Modified 2580 645 22033 Form none HHE Specific Worker Interview - example
HHE Specific Worker Questionnaire (Example) Modified 3700 1850 63196 Form none Specific Worker Questionnaire - example
Health Hazard Evaluation Request Form for Employees and Employers Modified 290 58 1981 Form none HHE Request Form
Initial Site-visit Followback Survey Year 1 Modified 244 41 1388 Form none Initial Site Visit Followback Survey - year 1
Total burden requested under this ICR: 9648 2956 100982  
To view an IC, click on IC Title