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Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires
NCHS Questionnaire Design Research Laboratory
OMB: 0920-0222
IC ID: 200032
OMB.report
HHS/CDC
OMB 0920-0222
ICR 201002-0920-006
IC 200032
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:
2022-12-21 - Revision of a currently approved collection
2021-08-16 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires
Form and Instruction
Survey on Respiratory Health
QDRL NIOSH Resp Health Attach1.doc
Form and Instruction
Blood Donor History Questionnaire
QDRL OASH Blood Donor Attach 1.doc
Form and Instruction
QDRL OMB-10-day combo letter.doc
Letter to Dr. Schwab
IC Document
QDRL NIOSH Resp Health Attach2.docx
Respiratory - Att 2 Flyer
IC Document
QDRL NIOSH Resp Health 10-day letter.doc
Respiratory - Letter to OMB
IC Document
QDRL OASH Blood Donor Attach 2abc.docx
Blood Donor - Att 2a Flyer
IC Document
QDRL OASH Blood Donor 10-day letter-fnl.doc
Blood Donor - Letter to OMB
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Respiratory Health of Healthcare Workers and Blood Donor History Questionnaires
Agency IC Tracking Number:
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
none
Survey on Respiratory Health
QDRL NIOSH Resp Health Attach1.doc
No
No
Paper Only
Form and Instruction
none
Blood Donor History Questionnaire
QDRL OASH Blood Donor Attach 1.doc
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Immunization Management
Privacy Act System of Records
Title:
Health and Demographic Surveys Conducted in Probablity Samples of the US Population
FR Citation:
49 FR 37693
Number of Respondents:
125
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
125
0
0
0
0
0
Annual IC Time Burden (Hours)
125
0
0
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Letter to Dr. Schwab
QDRL OMB-10-day combo letter.doc
10/31/2011
Respiratory - Att 2 Flyer
QDRL NIOSH Resp Health Attach2.docx
10/31/2011
Respiratory - Letter to OMB
QDRL NIOSH Resp Health 10-day letter.doc
10/31/2011
Blood Donor - Att 2a Flyer
QDRL OASH Blood Donor Attach 2abc.docx
10/31/2011
Blood Donor - Letter to OMB
QDRL OASH Blood Donor 10-day letter-fnl.doc
10/31/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.