Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Cognitive Testing of 2021 Occupational Health Supplement Questions
Agency IC Tracking Number:
0920-0222-20KP
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
0920-0222
Questions for Consideration NHIS-OHS 2021 Supplement
Att 2 - Questionnaire-2-24-2020.docx
No
Fillable Fileable
Instruction
Att 4ab - NIOSH telephone screener 020420-lc.docx
No
Printable Only
Form
0920-0222
Respondent Data Collection Sheet
Att 6 - NIOSH Resp Data Collect Sheet.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probability Samples of the U. S. Population 09-20-0164
FR Citation:
49 FR 37693
Number of Respondents:
75
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
75
0
75
0
0
0
Annual IC Time Burden (Hours)
23
0
23
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
10-day Letter
10-day letter_NIOSH_12-11-2020_REVISED-2-24-2020-CLEAN.docx
02/26/2020
NIOSH Res[ponse to Questions Raised by OMB
Att 1 - NIOSH Response to Qs 11-12-2019-REVISED-2-24-2020- CLEAN.docx
02/26/2020
Att 3a Semi-targeted Advertisement
Att 3ab - NIOSH Ad&Flyer.docx
02/26/2020
Att 5_Adult Informed Consernt Form for One-on-One Interviews
Att 5 - NIOSH informed consent 1121 2019-kw--1-9-2020-CLEAN.docx
02/26/2020
Att 7_Thank you letter
Att 7 - NIOSH Thank You Letter-1121 2019.docx
02/26/2020
Att 8_Special Consent for Expanded Use of Video and Audio Recordings
Att 8 - NIOSH Special Consent.docx
02/26/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.