View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 0704-0593	ICR Reference No: 202008-0704-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOW/DODDEP	Agency Tracking No: 0704-WECS
Title: Workplace Environment Changes and Safety Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 08/13/2020
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/15/2020
	Date Received in OIRA: 08/10/2020
Terms of Clearance: This collection is approved based on the revised materials provided by the Department for 6 months only. Should DOD wish to use this survey for longer than 6 months, the Department will need to publish a 60 and 30 day notice for this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	240	0	0
Time Burden (Hours)	20	0	0
Cost Burden (Dollars)	646	0	0

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	240	240
Annual Time Burden (Hours)	20	20
Annual Cost Burden (Dollars)	646	646

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is no change to burden, this is a new collection.

Annual Cost to Federal Government: $646

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

Agency Contact: Lane Purvis 571 372-0459 lane.m.purvis2.civ@mail.mil

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