Health Hazard Evaluations/Technical Assistance and Emerging Problems

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting statement Part B.doc	Supporting Statement B	Uploaded 2008-06-23	Available
Attachment E Consent Form (sample) and HSRB Approval sha1 2008.pdf	Supplementary Document	Uploaded 2008-06-23	Available
Attachment D Public comment and response sha1 2008 (2).doc	Supplementary Document	Uploaded 2008-06-23	Available
Attachment C 60D FRN.pdf	Supplementary Document	Uploaded 2008-06-23	Available
Attachment B - Title 42 Code of Federal Regulations Parts 85 and 85a.txt	Supplementary Document	Uploaded 2008-06-23	Available
Attachment A 91-596 + 91-173.doc	Supplementary Document	Uploaded 2008-06-23	Available
Supporting Statement Part A.doc	Supporting Statement A	Uploaded 2008-06-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37747	Health Hazard Evaluation Specific Questionnaire (Example)	Other-Questionnaire	Modified
185724	Followback II	Other-Survey	New
185723	Followback I	Other-Survey	New
185722	One Year Later Evaluation	Other-Survey	New
185721	Closeout Evaluation	Other-Evaluation	New
185720	Initial Site Visit Survey Form	Other-Survey	New
185719	Health Hazard Evaluation Specific Interview (Example)	Other-Health Hazard Evaluation Specific (example)	New
185718	Health Hazard Evaluation Request Form for Employees and Employers	Other-Questionnaire	New

ICR Details

OMB Control No: 0920-0260	ICR Reference No: 200807-0920-003
Status: Historical Active	Previous ICR Reference No: 200504-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Health Hazard Evaluations/Technical Assistance and Emerging Problems
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2009
	Date Received in OIRA: 07/16/2008
Terms of Clearance: Approved consistent with the following terms of clearance: 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.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved
Responses	11,690	0	0
Time Burden (Hours)	4,007	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Pursuant to its mandates under the Occupational Safety and Health Act of 1970 and the Federal Mine Safety and Health Act of 1977, and authorized by 42 CFR 85, NIOSH responds to requests for health hazard evaluations (HHEs) to identify chemical, biological or physical hazards in workplaces and provide guidance to reduce any hazards found. This is a request for reinstatement with minor changes.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act
   PL: Pub.L. 91 - 173 301 Name of Law: Federal Mine Safety and Health Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 19504	04/10/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 38222	07/03/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
Initial Site Visit Survey Form
Closeout Evaluation
Health Hazard Evaluation Specific Questionnaire (Example)
Health Hazard Evaluation Request Form for Employees and Employers
Health Hazard Evaluation Specific Interview (Example)
Followback II
One Year Later Evaluation
Followback I

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ICR Summary of Burden

table that charts list 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	11,690	0	0	11,690	0	0
Annual Time Burden (Hours)	4,007	0	0	4,007	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: No

Burden Reduction Due to:

Short Statement: This is a request for reinstatement with minor changes to forms which slightly reduce the burden and number of respondents.

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Annual Cost to Federal Government: $385,000

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 07/16/2008

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