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View Information Collection (IC)
View Information Collection (IC)
IC Title:
Tool Development for the Assessment of Uptake and Reach of NIOSH Exposure Assessment Research
Agency IC Tracking Number:
0920-20RL
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
n/a
Screening Questions
ATT3-E_Screening_Questions_10-01-20.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Semi-structured Interview Guide
ATT3-A_Semi_Structured_Script_10-01-20.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Cognitive Interview Guide
ATT4-Cog_Interview_Guide_10-01-20.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
67
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, Businesses or other for-profits
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
67
0
67
0
0
0
Annual IC Time Burden (Hours)
123
0
123
0
0
0
Annual IC Cost Burden (Dollars)
4,021
0
4,021
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Part A
Supporting Statement A_10-01-20.docx
10/01/2020
Supporting Statement Part B
Supporting Statement B_10-01-20.docx
10/01/2020
Authorizing Legislation: Occupational Safety and Health Act of 1970
ATT1_OSH Act of 1970.pdf
10/01/2020
Evaluation Plan
ATT2_UCESC_Evaluation_Plan.pdf
10/01/2020
Recruitment Emails
ATT3-B_Recruitment_Emails.docx
10/01/2020
Recruitment Emails for Professional Associations
ATT3-C_Recruitment_Professional_Associations.docx
10/01/2020
Referral Request
ATT3-D_Referral_Request.docx
10/01/2020
Scheduling Email
ATT3-F_Scheduling_Email.docx
10/01/2020
Study Information Sheet
ATT5_Study_Info_Sheet.docx
10/01/2020
Project Determination: Non-research (IRB approval not required)
ATT6_IRBDeterminationForm.pdf
10/01/2020
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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The .gov means it's official.
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