Information Collection

Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire

IC 201870 under ICR 201002-0920-006 · OMB 0920-0222.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1 Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire	Form and Instruction
Attachment 1 Respiratory Health Internet Version QDRL 2012 NIOSH Resp Health-Attach 1-v3.doc	Form and Instruction
QDRL 2012 NIOSH Resp Health -Attach 2a.docx QDRL 2012 NIOSH Resp Health -Attach 2a	IC Document
QDR L2012 NIOSH Resp Health - Attach 2b.docx QDR L2012 NIOSH Resp Health - Attach 2b	IC Document
QDRL 2012 NIOSH Resp Health 10-day letter 032912hr.doc QDRL 2012 NIOSH Resp Health 10-day letter 032912hr	IC Document

IC Title:

Evaluation of the Internet Version of the Respiratory Health of Healthcare Workers Questionnaire

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 1	Respiratory Health Internet Version	QDRL 2012 NIOSH Resp Health-Attach 1-v3.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: 09-20-0164 Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population

FR Citation: 49 FR 37693

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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	25	0	0	0	0	0
Annual IC Time Burden (Hours)	25	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
QDRL 2012 NIOSH Resp Health -Attach 2a	QDRL 2012 NIOSH Resp Health -Attach 2a.docx	04/03/2012
QDR L2012 NIOSH Resp Health - Attach 2b	QDR L2012 NIOSH Resp Health - Attach 2b.docx	04/03/2012
QDRL 2012 NIOSH Resp Health 10-day letter 032912hr	QDRL 2012 NIOSH Resp Health 10-day letter 032912hr.doc	04/03/2012

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