View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0260
ICR Reference No:
201109-0920-006
Status:
Historical Active
Previous ICR Reference No:
200807-0920-003
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Health Hazard Evaluations/Technical Assistance and Emerging Problems
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
11/17/2011
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/27/2011
Terms of Clearance:
Previous terms of clearance continue: Approved consistent with the following terms of clearance: approved for purposes of conducting investigations/evaluations, given the anecdotal nature of gathered data information obtained through these collections of information will not be used to develop estimates related to health or safety risks in general.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2014
36 Months From Approved
01/31/2012
Responses
8,160
0
11,690
Time Burden (Hours)
2,874
0
4,007
Cost Burden (Dollars)
0
0
0
Abstract:
PL 91-596 and PL 91-173 mandate that CDC's National Institute for Occupational Safety and Health (NIOSH) respond to request for Health Hazard Evaluations (HHEs) to address chemical, biological, and/or physical workplace hazards. CDC requests revisions to data collection forms for the Health Hazard Evaluation/Technical Assistance and Emerging Problems information collection.
Authorizing Statute(s):
PL:
Pub.L. 91 - 173 301
Name of Law: Federal Mine Safety and Health Act
US Code:
42 USC 85
Name of Law: Public Health Service Act
PL:
Pub.L. 91 - 596 20
Name of Law: Occupational Safety and Health Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
76 FR 40917
07/12/2011
30-day Notice:
Federal Register Citation:
Citation Date:
76 FR 58515
09/21/2011
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
8
IC Title
Form No.
Form Name
Follow-back without Onsite Evaluation Year 1
none
Followback no onsite Year 1
Follow-back without Onsite Evaluation Year 2
none
Follow-back no onsite Year 2
Followback for Onsite Evaluations Year 1
none
Followback Year 1
Followback for Onsite Evaluations Year 2
none
Followback Year 2
Health Hazard Evaluation Request Form for Employees and Employers
none
HHE Request Form
Health Hazard Evaluation Specific Interview (Example)
none
HHE Evaluation Ineview
Health Hazard Evaluation Specific Questionnaire (Example)
none
HHE Evaluation
Initial and Follow-back for Onsite Evaluations Year 1
none
HHE Initial and Follow-back
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
8,160
11,690
0
-3,530
0
0
Annual Time Burden (Hours)
2,874
4,007
0
-1,133
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The revisions made in this package are re-wording and re-ordering of questions contained in the five Followback questionnaires to improve the ease of responding by the questionnaire recipients. Similar changes have been made to the Health Hazard Evaluation (HHE) request forms in both the English and Spanish versions.
Annual Cost to Federal Government:
$450,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Daniel Holcomb 770 488-4472 dwh6@cdc.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
09/27/2011
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