Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(genIC) Feedback Survey for Community Counts Data Viz Tool New 300 15 0 Other-Screenshots
American Academy of Pediatrics Neurodevelopmental (ECHO) New 2550 507 0 Form and Instruction 0920-1154 Peditrician - ECHO Chart Review
Form and Instruction 0920-1154 Pediatrician - ECHO Session Satisfaction Survey
Form and Instruction 0920-1154 Pediatrician - ECHO Program Satisfaction Survey
Form and Instruction 0920-1154 Pediatrician - ECHO Debriefing Conference Call
American Academy of Pediatrics Resident Training in Developmental Continuity Clinics (part 3) New 160 32 0 Form and Instruction 0920-20MD Attachment A1_Attending Physicians_Screening & Diagnosis pretest
Form and Instruction 0920-20MD Attachment A2_Attending Physicians_Screening & Diagnosis post test
Form and Instruction 0920-20MD Attachment A3_Attending Physicians_Treatment Across Lifespan pretest
Form and Instruction 0920-20MD Attachment A4_Attending Physicians_Treatment Across Lifespan post test
Form and Instruction 0920-20MD Attachment A5_Attending Physicians_Overcoming Social Attitudes pretest
Form and Instruction 0920-20MD Attachment A6_Attending Physicians_Overcoming Social Attitudes post test
Form and Instruction 0920-20MD Attachment A7_Attending Physicians_Educational Care pretest
Form and Instruction 0920-20MD Attachment A9_Attending Physicians_Training Program Evaluation
Form and Instruction 0920-20MD Attachment A10_Resident_Overall Effects & Prevalence video pretest
Form and Instruction 0920-20MD Attachment A11_Resident_Overall Effects & Prevalence video post test
Form and Instruction 0920-20MD Attachment A12_Resident_Overall Program Evaluation
Form and Instruction 0920-20MD Attachment A13_Attending Physician_Overall Program Evaluation
ArboNET Needs Assessment New 60 60 0 Form 0920-1154 ArboNET Needs Assessment
Characterization of Haul Truck Health and Safety Issues New 120 120 0 Form and Instruction 0920-20IU Cognitive Task Analysis (CTA) Interview Guide
Form and Instruction 0920-20IU Critical Decision Method (CDM) Semi-Structured Interview Guide
Connecting the Dots Across Injury Prevention Bullying and Substance Use Prevention Message Testing  New 64 71 1949 Form and Instruction None Screener for Parents and Caregivers
Form and Instruction None Recruitment Emails for Practitioners
Form and Instruction None Parent and Caregiver Focus Group Discussion Guide
Form and Instruction None Bullying Prevention Practitioner Focus Group Discussion Guide
Form and Instruction None Substance Use Prevention Practitioner Focus Group Discussion Guide
Customer Discovery Interviews with Small Outdoor Service Businesses New 25 25 0 Other-WORD
Other-Script
DREXEL-CYSHCN New 400 878 0 Instruction
Other-WORD
Form 0920-1154 DREXEL -DEMOGRAPHIC INTAKE FORM
Form and Instruction 0920-1154 DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL
Form 0920-1154 INTERVIEW GUIDE FOR BRIEF FAMILY INTERVIEW
Form and Instruction 0920-1154 DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL -- revised
Form and Instruction 0920-1154 DISASTER PREPAREDNESS HOME ASSESSMENT SCREENING TOOL -- revised
Determining Barriers to Hearing Conservation Program Success through Worker Interviews New 40 40 0 Other-Interview guide
Drug Overdose Prevention Information Needs Among African Americans, People Living in Rural Areas, and Young People Ages 12-17 Years Old New 300 109 0 Form and Instruction 0920-1154 Parent Consent Form
Form and Instruction 0920-1154 Screener Parents of Young People
Form and Instruction 0920-1154 Information Sheet for Young People
Form and Instruction 0920-1154 Moderators Guide for Young People
Form and Instruction 0920-1154 Screener African Americans
Form and Instruction 0920-1154 Moderators Guide for African Americans
Form and Instruction 0920-1154 Screener Rural Participants
Form and Instruction 0920-1154 Moderators Guide for Rural Participants
Farm to Table: Knowledge Base Preventing Musculoskeletal Disorders Among Food and Beverage Workers New 126 189 5198 Form and Instruction n/a Focus Group Guide (script) for Stakeholders
Form and Instruction n/a Focus Group Guide (script) for Workers
Federal Select Agent Program Feedback Survey New 247 41 0 Form and Instruction 0920-22EM Federal Select Agent Program Feedback Survey
Field Testing of an Instrument to Assess the Uptake and Reach New 550 138 0 Form and Instruction 0920-1154 NIOSH Study Evaluation Survey
Focus Group Study of U.S. Adult's Knowledge and Attitudes for Salmonella Infections and Keeping Backyard Poultry New 554 123 0 Form none Screener
Other-Focus group guide
Focus Group Study of U.S. Adults' Knowledge and Attitudes of Irradiation as a Food Safety Intervention New 400 165 0 Form 0920-1154 Screening Instrument for Focus Groups
Form and Instruction 0920-1154 Moderator's Guide for Focus Group
Form and Instruction 0920-1154 Moderator's Guide for Focus Group Set 2
Form 0920-1154 Irradiation and Food Safety
Food Safety Communication Evaluation: Focus Groups Assessing Food Safety Messages, Knowledge, and Attitudes New 4844 646 0 Form and Instruction 0920-1154 Eligibility and Demographic Screener
Form and Instruction 0920-1154 Focus Group Moderator Guide - General
Form and Instruction 0920-1154 Focus Group Moderator Guide - Parents
Form and Instruction 0920-1154 Focus Group Moderator Guide - Pregnant
Form and Instruction 0920-1154 Respondent Technology Screener
Formative Assessment of the Information Needs of Adapting NIOSH-CPWR toolbox talks for Spanish-speaking construction workers: Phase 1 New 72 108 0 Form and Instruction 0920-20LK NIOSH Toolbox Focus Group Guide
Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise New 35 19 0 Form and Instruction 0920-21EY VRMine_Attachment_B_Exploration Team Survey
Form and Instruction 0920-21EY VRMine_Attachment_C_Briefing Officer Survey
Form and Instruction 0920-21EY Team Trainers Survery
Formative Evaluation of an Immersive VRMine Rescue Contest Simulation Exercise New 35 18 364 Form and Instruction n/a Exploration Team Survey
Form and Instruction n/a Briefing Officer Survey
Form and Instruction n/a Team Trainer Interview Questions
Formative Research and Tool Development - "Strengthening hospital-based youth violence prevention New 45 45 0 Form and Instruction 0920-1154 Interview Guide
Formative Research to Support Active Surveillance of Myalgic Encelphalomyelitis/Chronic Fatigue Syndrome Among Schoolchildren New 116 228 0 Form none Electronic Platform Chronic Absenteeism Reporting Form
Form none Demographic Data Collection Points
Form none Pilot Site Baseline Survey
Form none Webinar Feedback Form
Other-Question Guide
Form none School District Feedback Form
HEADS UP! Parents Feedback New 708 108 0 Other-Recruitment Materials
Form and Instruction 0920-1154 Screening Form
Other-Email
Form and Instruction 0920-1154 Focus Group Discussion Guide and Consent
Health Education and Health Promotion in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Knowledge, Attitudes and Beliefs in the U.S. General Public New 3800 530 13249 Form and Instruction n/a Screener
Form and Instruction n/a Survey
Integrating Comprehensive Family-Centered Care into Substance Use Treatment Programs for Pregnant and Postpartum Women to Prevent the Intergenerational Transmission of Adverse Childhood Experiences New 400 101 0 Form and Instruction 0920-1154 Survey Questionnaire
Knowledge, Attitudes, and Perceptions of Shigellosis Related Prevention Behaviors Among Men Who Have Sex With Men New 530 113 2633 Form and Instruction n/a Screener
Form and Instruction n/a Interview Guide
Mapping experiences of young adults and families impacted by adverse childhood experiences (ACEs) New 300 200 0 Form and Instruction 0920-1154 Conversation Guide for Parents and Young Adults
Form and Instruction 0920-1154 Conversation Guide for Social Service Providers
Form and Instruction 0920-1154 Virtual Focus Group Guide
Instruction
Form and Instruction 0920-1154 Recruitment Screener
Pre/Post Draft Heat Stress Focus Group/Training with Outdoor Workers New 414 531 0 Other-Paper
Other-Paper
Form 0920-1154 Training for Employers Pre-Test
Form 0920-1154 Training for Employers Post-Test
Seat belt use among workers who drive as part of their job: what's not "clicking"? New 60 140 0 Other-WORD
Other-WORD
Other-WORD
Other-WORD
Strengthening Public Health Incident Management Through Continuous Quality Improvement New 1272 664 0 Form and Instruction 0920-1255 Incident Background Information
Form and Instruction 0920-1255 Peer Assessor Protocol
Form and Instruction 0920-1255 IM Team Survey
Form and Instruction 0920-1255 Interview Guide
Strengthening hospital-based youth violence prevention New 45 45 0 Form and Instruction 0920-1154 Interview Guide
Tabletop Exercise-- Home Assessments for Patients and Families with Special Health Care Needs Developing Tools, Communication Strategies, and Standards New 32 102 0 Form and Instruction 0920-22HH Att B Tabletop Exercise Question Bank and Guide (for Moderators)
Form and Instruction 0920-22HH Att C Tabletop Exercise CYSHCN Feedback Form
Form and Instruction 0920-22HH AttD - Exercise Evaluation Form and Guide - CYSHCN TTX
Tool Development for the Assessment of Uptake and Reach of NIOSH Exposure Assessment Research New 67 123 4021 Form and Instruction n/a Screening Questions
Form and Instruction n/a Semi-structured Interview Guide
Form and Instruction n/a Cognitive Interview Guide
Use of Hand Sanitizer Among U.S. Adults: A Formative Qualitative Evaluation New 530 114 0 Form 0920-1154 Screener
Form and Instruction 0920-1154 Interview Moderator Guide
Youth and Young Adult Formative In-Depth Interviews on Health Equity and Tobacco Use New 450 144 0 Form and Instruction 0920-1154 Parent/Guardian Email and Informed Consent
Form and Instruction 0920-1154 Parent/Guardian Email and Informed Consent
Form and Instruction 0920-1154 Young Adult Informed Consent
Form and Instruction 0920-1154 Parent/Guardian Email and Youth Informed Assent
Form and Instruction 0920-1154 Young Adult Recruitment Screener Questionnaire
Form and Instruction 0920-1154 Youth Recruitment Screener Questionnaire
Form and Instruction 0920-1154 Interview Guide
[2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum New 72 84 2178 Form and Instruction None Safety Skills at Work Pre-Survey
Form and Instruction None Safety Skills at Work Post-Survey
Form and Instruction None Safety Skills at Work Follow-up Survey
Form and Instruction None Safety Skills at Work Post-Training Feedback Session Questions
[NCIPC] HEADS UO Outreach to At Risks Groups--Formative Testing New 500 89 0 Form and Instruction 0920-1154 Focus Group Recruitment Materials - Parents
Form and Instruction 0920-1154 Consent Form - Parent Participant
Instruction
Form and Instruction 0920-1154 Focus Group Guide: Parents
Form and Instruction 0920-1154 Focus Group Recruitment Materials - Youth
Form and Instruction 0920-1154 Consent Form - Parent of Youth Participant
Instruction
Form and Instruction 0920-1154 Focus Group Guide: Youth
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 20223 6665 29592  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title