Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Employee - HHE Specific Medical Survey Informed Consent Modified 60 30 0 Form and Instruction 0920-0260
Employee Representative - Closeout for HHE without Site Visit - Year 1 Removed 0 0 0 Form and Instruction 0920-0260
Employee Representative Closeout for HHE without Site Visit - Year 2 Removed 0 0 0 Form and Instruction 0920-0260
Employees - Contact Postcard Modified 1225 102 0 Form and Instruction 0920-0260
Employees - HHE Specific Questionnaire Example Modified 2100 1050 0 Form and Instruction 0920-0260
Employees - HHE specific interview example Modified 1470 368 0 Form and Instruction 0920-0260
Employees/ employee representatives/ or employers - HHE Request Form Unchanged 250 50 0 Form and Instruction 0920-0260
Form and Instruction 0920-0260
Employer and Employee Representative - Closeout HHE Followback Survey with Site Visit Removed 0 0 0 Form and Instruction 0920-0260
Employer and Employee Representative - HHE Followback Survey with Site Visit - Year 2 Removed 0 0 0 Form and Instruction 0920-0260
Followback for Without Onsite Evaluations New 188 40 0 Form 0920-0260
Form 0920-0260
Followback for Onsite Evaluations Modified 420 105 0 Form 0920-0260
Form 0920-0260
Form 0920-0260
Total burden requested under this ICR: 5713 1745 0  
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