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:
0920-1331
ICR Reference No:
202008-0920-005
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-20HO
Title:
Heat-related Changes in Cognitive Performance
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/24/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
09/02/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
03/31/2024
36 Months From Approved
Responses
936
0
0
Time Burden (Hours)
103
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of this study is to collect information on burden of heat strain among miners as well as factors related to personal risk and core body temperature that contribute to individual variability in heat tolerance and to declines in heat-related worker performance. The proposed program is a step toward meeting NIOSH and industry goals in addressing heat strain among miners. To prioritize future occupational safety and health research and prevention activities in each major industry sector, NIOSH organized national sector councils comprised of representatives from NIOSH, industry, organized labor, and academia. The Mining Sector Council (MSC) identified critical knowledge gaps and research needs in its National Mining Agenda in 2015.
Authorizing Statute(s):
None
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 10697
02/25/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 51439
08/20/2020
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
19
IC Title
Form No.
Form Name
Appx C - Health screening questionnaire - Field app (M)
Appx D - Heat Stress app -- shift questionnaire for field (M)
Appx E - Heat stress app - post-shift questionnaire (field) (M)
Appx F_Physcal Examination (M/FF/CW)
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)
Appx H_PANAS sleepiness fatigue (M/FF/CW)
Appx I_ Pre-Test Questionnaire (M/FF/CW)
Appx L_Consent Form Field Study (M)
0920-
Health-related changes in cognitive performance - Field component
Appx M_ Consent Form Environment Chamber (M/FF/CW)
0920
Health-related changes in cognitive performance Environmental chamber component
Borg and Thermal Scale (M/FF/CW)
0920
Bor and Thermail Sensaton Scale
Cognitive test: N-back -- no form (M/FF/CW)
Fingerstick blood sample for point of care testing
Fitting of Chest Strap (M)
Fitting of Chest Strap (M/FF/CW)
Ingestion of Temperature Pill (M)
Ingestion of Temperature Pill (M/FF/CW)
PVT Cognitive Test - Field (M)
PVT Cognitive Test - Field (M/FF/CW)
Release of Information (HIPPA) (M/FF/CW)
0920
Release of Information (HIPAA Privacy Authorization Form)
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
936
0
0
786
150
0
Annual Time Burden (Hours)
103
0
0
88
15
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:
No
Burden Reduction Due to:
Short Statement:
This is a NEW information collection request.
Annual Cost to Federal Government:
$452,560
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.
Yes
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:
09/02/2020
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