View Information Collection Request (ICR) Package
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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:
202005-0920-003
Status:
Historical Active
Previous ICR Reference No:
201708-0920-027
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0260
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:
03/11/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/03/2020
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
03/31/2024
36 Months From Approved
03/31/2021
Responses
5,653
0
9,648
Time Burden (Hours)
1,715
0
2,956
Cost Burden (Dollars)
58,545
0
100,982
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.
Authorizing Statute(s):
PL:
Pub.L. 101 - 552 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:
85 FR 7560
02/10/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 33679
06/02/2020
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
Att C_Request for a Health Hazard Evaluation (Employees and Employers)
0920-0260
HHE Request Form
Att D_Sample HHE Specific Worker Interview
0920-0260
HHE Specific Worker Interview - example
Att F_Sample HHE Specific Worker Questionnaire
0920-0260
Specific Worker Questionnaire - example
Att G_Sample Employee Contact Information Postcard
0920-0260
Sample Employee Contact Information Postcard
Att H_ Initial Site Visit Followback Survey Form
0920-0260
Initial Site Visit Followback Survey Form
Att I_ HHE Survey - FINAL Report (with site visit)
0920-0260
HHE Survey - FINAL Report
Att J_HHE Followback Survey - FINAL Report - 1Yr Later
0920-0260
HHE Followback Survey - FINAL Report - 1YR Later
Att K_Followback Survey – Final Letter
0920-0260
Followback Survey (Closeout for HHE without site vite)
Att L_Followback Survey: One Year Later
0920-0260
Followback without Onsite Evaluation - year 1
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
5,653
9,648
0
-3,995
0
0
Annual Time Burden (Hours)
1,715
2,956
0
-1,241
0
0
Annual Cost Burden (Dollars)
58,545
100,982
0
-42,437
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Changing Forms
Short Statement:
No new forms have been added to this request. The estimated total burden is reduced by 1244 hours. This reduction is accounted for by adjustments (decrease, as noted in recent trends) to the expected number of HHE requests and onsite evaluations, and therefore respondents.
Annual Cost to Federal Government:
$6,300,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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?
No
Agency Contact:
Thelma Sims 4046394771
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:
06/03/2020
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