Information Collection

Healthcare Workers Primary Hazard Module

IC 192661 under ICR 201004-0920-008 · OMB 0920-0860.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 6 Healthcare Workers Primary Hazard Module	Form and Instruction
3 Healthcare Workers Primary Hazard Module Attachment I2_Module A_FINAL_08042010.docx	Form and Instruction
5 Antineoplastic Agents (Administer) Attachment I4_Module C_FINAL_8042010.docx	Form and Instruction
4 Antineoplastic Agents (Compound) Attachment I3_Module B_FINAL_08042010.docx	Form and Instruction
6 Chemical Sterilants Attachment I5_Module D_TC_72310.docx	Form and Instruction
7 High Level Disinfectants Attachment I6_Module E_TC.docx	Form and Instruction
8 Surgical Smoke Attachment I7_Module F_TC_72310.docx	Form and Instruction
9 Anesthetic Gases Attachment I8_Module G_TC_72310.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	6	Chemical Sterilants	Attachment I5_Module D_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Healthcare Workers Primary Hazard Module	Attachment I2_Module A_FINAL_08042010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	Antineoplastic Agents (Compound)	Attachment I3_Module B_FINAL_08042010.docx	Yes	Yes	Fillable Fileable
Form and Instruction	9	Anesthetic Gases	Attachment I8_Module G_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	8	Surgical Smoke	Attachment I7_Module F_TC_72310.docx	Yes	Yes	Fillable Fileable
Form and Instruction	7	High Level Disinfectants	Attachment I6_Module E_TC.docx	Yes	Yes	Fillable Fileable
Form and Instruction	5	Antineoplastic Agents (Administer)	Attachment I4_Module C_FINAL_8042010.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,520

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: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20,520	20,520
Annual IC Time Burden (Hours)	3,420	3,420
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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