View Information Collection (IC)
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:
Seat belt use among workers who drive as part of their job: what's not "clicking"?
Agency IC Tracking Number:
0920-1154-21IB
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
Other-WORD
Attachment B _Worker Interview Guide.docx
No
Paper Only
Other-WORD
Attachment C_Supervisor_Managers Focus Group Guide.docx
No
Paper Only
Other-WORD
Attachment F_Information about the study for workers and recruitment script.docx
No
Paper Only
Other-WORD
Attachment G_Information about the study for supervisors_managers and recruitment script.docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
60
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
60
0
60
0
0
0
Annual IC Time Burden (Hours)
140
0
140
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
SSA
Supporting_Statement_A_ SB study 09072021.docx
09/16/2021
SSB
Supporting_Statement_B_SB study 09072021.docx
09/20/2021
OSH Act
Attachment A- OSH Act.docx
09/20/2021
Worker Recruitment Materials (English version)
Attachment D_Worker recruitment materials.docx
09/20/2021
Manager/Supervisor Recruitment Materials
Attachment E_Manager_supervisor recruitment materials.docx
09/20/2021
Worker Consent Form
Attachment H_Worker consent form.docx
09/20/2021
Supervisor/Manager Consent Form
Attachment I_Manager_Supervisor consent form.docx
09/20/2021
IRB Approval Letter
Attachment J_IRB approval letter.pdf
09/20/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.