Information Collection

Secondary Hazard Module

IC 192662 under ICR 201004-0920-008 · OMB 0920-0860.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Antineoplastic Agents (Compound) Secondary Hazard Module	Form and Instruction
Form 3 Healthcare Workers Primary Hazard Module Secondary Hazard Module	Form and Instruction
Form 5 Antineoplastic Agents (Administer) Secondary Hazard Module	Form and Instruction
Form 6 Chemical Sterilants Secondary Hazard Module	Form and Instruction
Form 7 High Level Disinfectants Secondary Hazard Module	Form and Instruction
Form 8 Surgical Smoke Secondary Hazard Module	Form and Instruction
Form 9 Anesthetic Gases Secondary 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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	3	Yes	Yes	Fillable Fileable
Form and Instruction	5	Yes	Yes	Fillable Fileable
Form and Instruction	4	Yes	Yes	Fillable Fileable
Form and Instruction	6	Yes	Yes	Fillable Fileable
Form and Instruction	7	Yes	Yes	Fillable Fileable
Form and Instruction	8	Yes	Yes	Fillable Fileable
Form and Instruction	9	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,052

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	2,052	2,052
Annual IC Time Burden (Hours)	342	342
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.

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