View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Field Testing of an Instrument to Assess the Uptake and Reach	Agency IC Tracking Number:	0920-1154-22FJ

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 and Instruction	0920-1154	NIOSH Study Evaluation Survey	ATT2_NIOSH Survey.docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 550	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	550	0	550	0	0	0
Annual IC Time Burden (Hours)	138	0	138	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
SSA	Supporting Statement A_5-10-22 (002).docx	05/11/2022
SSB	Supporting Statement B_5-2-22.docx	05/11/2022
OSH Act of 1970	ATT1_OSH Act of 1970.pdf	05/11/2022
Att 3_Recruitment Email	ATT3_Recruitment_Emails.docx	05/11/2022
Att 4_IRB Designation	ATT4_IRB_Designation.pdf	05/11/2022

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