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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NIOSH] Assessing Human Factors in Fire Service Fatalities and Injuries
Agency IC Tracking Number:
0920-26-0169
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
Survey: Assessing Human Factors in Fire Service Fatalities and Injuries
Attachment F(a)_Survey Instrument_clean.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:
5,425
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
5,425
0
5,425
0
0
0
Annual IC Time Burden (Hours)
1,537
0
1,537
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Recruitment Email Invitation
Attachment A_Survey Recruitment Email Invitation.docx
06/16/2026
Recruitment Informational Slide
Attachment B_Survey Recruitment Informational Slide.pdf
06/16/2026
Email Reminder for FDs
Attachment C_Survey Email Reminder for FDs.docx
06/16/2026
Email Reminder for NIOSH COs
Attachment D_Survey Email Reminder from NIOSH COs.docx
06/16/2026
Electronic Informed Consent
Attachment E_Electronic Informed Consent.docx
06/16/2026
Survey Instrument REDcap
Attachment F(b)_Survey Instrument REDCap.pdf
06/16/2026
Research Determination
Attachment G_IRB Exempt Determination.pdf
06/16/2026
Protocol
Attachment H_IRB-Approved Protocol.docx
06/16/2026
Sampling Plan
Attachment I_Sampling Plan_0920-1450-DSR Human Factors.docx
06/16/2026
PIA Request
Attachment J_Privacy Act Determination Request.pdf
06/16/2026
Data Capture REDCap
Attachment K_Research Electronic Data Capture REDCap 4232024.pdf
06/16/2026
PTA
Attachment L_20260305_REDCAP_PTA.pdf
06/16/2026
GenIC Request Template
NIOSH genIC_Request to Debit Hours_0920-1450_OMB Passback response tc 6.15.26_final.docx
06/16/2026
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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