View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Psychological Safety Assessment	Agency IC Tracking Number:

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	Survey	Psychological Safety Assessment	Psychological Safety Assessment.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: Psychological Safety Assessment	FR Citation: 85 FR 81551

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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	200	0	200	0	0	0
Annual IC Time Burden (Hours)	10	0	10	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
DS-4183	Psychological Safety Assessment_signed_ds4183.pdf	10/06/2022
Business and Case Info	IRM DEIA Training_Assessment Business Case and Info_8232022.docx	10/06/2022

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