Information Collection

Assessment of Occupational Exposure Management

IC 180121 under ICR 200705-0920-005 · OMB 0920-0757.

Documents and Forms

Document Name Document Type
Assessment of Occupational Exposure Management Form and Instruction
Ambulatory Care Facilities Attachment D. CDC_AMB_final.pdf Form and Instruction
Long-term Care Facilities Attachment E. CDC_LTC_final.pdf Form and Instruction
Acute Care Facilities Attachment C. CDC_ACC_final.pdf Form and Instruction
Dialysis Centers Attachment F. CDC_DIAL_final.pdf Form and Instruction
Attach B invitation_prenot_rev050207.doc Pre-notification Letter IC Document
Attach G first_cover_rev05022007.doc First Cover Letter to Respondents IC Document
Attach H second_cover_rev05022007.doc Second Cover Letter to Respondents IC Document
Attachment I. AMB_Screen shots.pdf Example Screen Shots for Ambulatory CCs IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessment of Occupational Exposure Management	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Ambulatory Care Facilities	Attachment D. CDC_AMB_final.pdf	Yes	Yes	Fillable Printable
Form and Instruction	None	Long-term Care Facilities	Attachment E. CDC_LTC_final.pdf	Yes	Yes	Fillable Printable
Form and Instruction	None	Acute Care Facilities	Attachment C. CDC_ACC_final.pdf	Yes	Yes	Fillable Printable
Form and Instruction	None	Dialysis Centers	Attachment F. CDC_DIAL_final.pdf	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,320	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,320	5,320
Annual IC Time Burden (Hours)	1,773	1,773
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Pre-notification Letter	Attach B invitation_prenot_rev050207.doc	05/02/2007
First Cover Letter to Respondents	Attach G first_cover_rev05022007.doc	05/02/2007
Second Cover Letter to Respondents	Attach H second_cover_rev05022007.doc	05/02/2007
Example Screen Shots for Ambulatory CCs	Attachment I. AMB_Screen shots.pdf	05/02/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.