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:
202311-0920-010
Status:
Active
Previous ICR Reference No:
202005-0920-003
Agency/Subagency:
HHS/CDC
Agency Tracking No:
0920-0260
Title:
[NIOSH] 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:
01/03/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/28/2023
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
01/31/2027
36 Months From Approved
03/31/2024
Responses
7,043
0
5,653
Time Burden (Hours)
2,267
0
1,715
Cost Burden (Dollars)
0
0
58,545
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. This Revision ICR requests the following: 1) Addition of one new informed consent form; 2) Updating Spanish and English HHE Request Forms to add an additional 15 site visits; 3) Modification of FollowBack forms to reduce redundancy; and 4) Update the data collection in ROCIS to accurately reflect ongoing activities. Overall burden is increased by 552 hours.
Authorizing Statute(s):
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
PL:
Pub.L. 101 - 552 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:
88 FR 50155
08/01/2023
30-day Notice:
Federal Register Citation:
Citation Date:
88 FR 82897
11/27/2023
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
10
IC Title
Form No.
Form Name
Employee - HHE Specific Medical Survey Informed Consent
0920-0260
HHE Specific Medical Survey Informed Consent Form
Employee Representative - Closeout for HHE without Site Visit - Year 1
0920-0260
Followback Survey – One Year After - Final Letter
Employee Representative Closeout for HHE without Site Visit - Year 2
0920-0260
Followback Survey – One Year After Final Letter
Employees - Contact Postcard
0920-0260
HHE Contact Postcard
Employees - HHE Specific Questionnaire Example
0920-0260
HHE Specific Questionnaire Example
Employees - HHE specific interview example
0920-0260
HHE - Specific Interview Example
Employees/ employee representatives/ or employers - HHE Request Form
0920-0260, 0920-0260
Request for a Health Hazard Evaluation - English
,
Request for a Health Hazard Evaluation - Spanish
Employer and Employee Representative - Closeout HHE Followback Survey with Site Visit
0920-0260
Followback Survey – One Year After the Final Report
Employer and Employee Representative - Followback for Onsite Evaluations – Year 1
0920-0260, 0920-0260
Followback Survey – After HHE Site Visit
,
Followback Survey – After HHE - Final Report
Employer and Employee Representative - HHE Followback Survey with Site Visit - Year 2
0920-0260
Followback Survey – After HHE Final Letter
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
7,043
5,653
0
1,390
0
0
Annual Time Burden (Hours)
2,267
1,715
0
552
0
0
Annual Cost Burden (Dollars)
0
58,545
0
-58,545
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:
Revision submitted for 0920-0260 requests multiple changes to approved data collection and overall increase of 552 burden hours.
Annual Cost to Federal Government:
$5,700,000
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:
Jeffrey Zirger 404 639-7118 wtj5@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:
11/28/2023
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