View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Survey to Improve Worker Notification Efforts	Agency IC Tracking Number:	15YM

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Worker Notification Survey	survey #1_with cover letter-33115.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	3,000	0	3,000	0	0	0
Annual IC Time Burden (Hours)	500	0	500	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	OMB form_survey tools_survey #1.docx	04/22/2015
Cover Letter	Cover letter.docx	04/22/2015
Postcard	Example Post Card.docx	04/22/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.