Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Communication Community of Practice Meetings New 244 41 0 Form and Instruction 0920-0953 Survey Questionnaire
Customer Survey to Solicit Feedback on NIOSH Workplace Guidance Documents New 82632 6887 0 Form and Instruction n/a Questionnaire
Data collection for evidence-based revisions to the Fire Fighter Fatality Investigation and Prevention Program Line of Duty Death reports New 100 107 0 Other-Screening questions
Other-Script for verbal informed consent
Other-Semi-structured interview guide (no investigation)
Other-Semi-structured interview guide (w/ investigation)
[2022] Occupational Exposure Banding (OEB) Evaluation Survey New 500 83 0 Form and Instruction n/a NIOSH Occupational Exposure Banding Survey
Form and Instruction n/a NIOSH Occupational Exposure Banding Survey (PDF of Survey Monkey)
[CSELS] DLS CLPF Meeting Evaluation Survey 2022 New 40 3 0 Form and Instruction None Clinical Laboratory Partners Forum meeting evaluation survey
[NIOSH] : Satisfaction Survey for three-part virtual workshop series on Impact Wellbeing™ Guide New 150 39 0 Form and Instruction 0920-0953 Getting Started to Impact Wellbeing Virtual Workshop Feedback Form - Survey 1
Form and Instruction 0920-0953 Fostering a Safe, Supportive Work Environment Virtual Workshop Feedback Form - Survey 2
Form and Instruction 0920-0953 Building a System Where Healthcare Workers Thrive Virtual Workshop Feedback Form
[NIOSH] Data collection for evidence-based revisions to the Fire Fighter Fatality Investigation and Prevention Program's Medical Line of Duty Death reports New 30 76 0 Other-WORD
Other-WORD
Other-WORD
Other-WORD
[NIOSH] Focus groups to obtain input from construction workers and employers New 54 84 0 Form and Instruction 0920-23ET CDC Focus Group Discussion Guide_Attachment 1
Form and Instruction 0920-23ET CDC Focus Group Discussion Guide - Attachment 2_SPANISH
Form and Instruction 0920-23ET CDC Focus Group Discussion Guide_Attachment 3_employers_supervisors
[NIOSH] NIOSH Approved Radiograph Facility Quality Assurance Program Customer Satisfaction Survey New 153 8 0 Form n/a Survey Questions
[NIOSH] NIOSH Health Worker Mental Health Campaign: Implementation Guide Usability Testing New 660 330 0 Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #1
Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #2
Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #3
Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #4
Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #5
Form and Instruction None NIOSH Health Worker Mental Health Campaign Implementation Guide Feedback Survey #6
Form and Instruction None Check-in Session Discussion Guide
[NIOSH] Usability Testing of Toolbox Talks for Landscaping and Tree Care Workers New 60 65 0 Form and Instruction n/a Usability Testing Guide
Form and Instruction n/a Informed Consent
Form and Instruction n/a Usability Testing Guide (Spanish)
Form and Instruction n/a Informed Consent (Spanish)
[NIOSH] Virtual Focus Groups to Obtain Feedback from Retail Employers and Employees on WMSDs and STFs New 48 76 0 Form and Instruction None Screening Tool for Recruitment: Employers
Form and Instruction None Screener and Demographic Questionnaire: Workers
Form and Instruction None Employee Focus Groups Older Workers
Form and Instruction None Employee Focus Groups Younger Workers
Form and Instruction None Employers Focus Group
[NIOSH] Worker Notification User Feedback Survey (Comment Card) New 500 21 0 Form and Instruction n/a Survey
[NOISH] Mental Health Campaign Website Feedback Survey New 700 23 0 Form 0920-0953 Evaluation of the NIOSH Healthcare Worker Mental Health Campaign
[NOISH] NORA Services Sector Council Member Questionnaire New 60 20 0 Form 0920-0953 NORA Services Sector Council Member Questionnaire
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 85931 7863 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title