View Information Collection Request (ICR) Package
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Burden
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View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
201408-0920-011
Status:
Historical Active
Previous ICR Reference No:
201109-0920-006
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:
11/17/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/09/2014
Terms of Clearance:
Previous terms of clearance continue: 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
11/30/2017
36 Months From Approved
11/30/2014
Responses
9,931
0
8,160
Time Burden (Hours)
3,019
0
2,874
Cost Burden (Dollars)
0
0
0
Abstract:
PL 91-596 and PL 91-173 mandate that the National Institute for Occupational Safety and Health respond to requests for Health Hazard Evaluations (HHEs) to address chemical, biological, and/or physical workplace hazards. Responses require a valid written response; NIOSH receives about 300 requests per year. The diversity of requests precludes set questionnaires for the evaluations; a set of questionnaires for follow-back is used to assess HHE program effectiveness. Requests come from companies involving service, manufacturing, health and social services, transportation, construction, agriculture/mining, and skilled trades. CDC requests minor revisions to data collection forms and the addition of an employee contact postcard.
Authorizing Statute(s):
PL:
Pub.L. 91 - 596 20
Name of Law: Occupational Safety and Health Act
US Code:
42 USC 85
Name of Law: PHSA- Requests for HHE
PL:
Pub.L. 91 - 173 301
Name of Law: Federal Mine 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:
79 FR 19337
04/08/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 51338
08/28/2014
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
9
IC Title
Form No.
Form Name
Employee Contact Information Postcard - example
none
Employee Contact Information Postcard
Final Followback Report for Site-visits Year 1
none
Final Followback Survey Report for Site-visits
Followback for Site-visit Evaluations Year 2
none
Final Followback Survey for Site-visits Year 2
Followback without Site-visit Evaluation Year 1
none
Followback without Site-visit Evaluation Year 1
Followback without Site-visit Evaluation Year 2
none
Followback without Site-visit Evaluation Year 2
HHE Specific Interview (Example)
none
HHE Specific Interview - example
HHE Specific Worker Questionnaire (Example)
none
HHE Specific Worker Questionnaire - example
Health Hazard Evaluation Request Form for Employees and Employers
none, none
HHE Request Form for employees and employers
,
HHE Request form
Initial Site-visit Followback Survey Year 1
none
Initial Site-visit Followback Survey
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
9,931
8,160
0
1,771
0
0
Annual Time Burden (Hours)
3,019
2,874
0
145
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:
This revision includes minor changes to data collection forms, new estimates of the number of Health Hazard Evaluations and respondents, and the addition of an employee contact postcard. The total burden estimate in the supporting statement is off by 1 due to rounding.
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:
Shari Steinberg 404 639-4942 sxw2@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:
09/09/2014
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