Information Collection

Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul

IC 205130 under ICR 201111-0920-003 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment D - Moderator's Guide.docx	Instruction
Attachment E - Participant Information Sheet.docx	Instruction
Attachment C- Screen Shots.pdf	Other-Screen shots
Attachment D - Sleep Debt PSA_30 seconds.mp3	Other-video
Attachment F - Whole World Changes PSA_60 seconds.mp3	Other-video
Attachment E - Whole World Changes PSA_30 seconds.mp3	Other-video
Attachment B-Recruitment Script_Spanish.docx	Other-Recruitment Script_Spanish
Attachment C-Recruitment Script_English Translation.docx	Other-Recruitment Script_English Tra
FinalScript_English_051812.doc	Other-Test
FinalScript_Spanish_051812.doc	Other-Test
GeneralTest113012v01.pdf	Other-Test document
HotelTest113012v01.pdf	Other-Testing document
SoftskillsTest120312v01.pdf	Other-Testing document
Screening Instrument Attachment C - Screening Instrument.docx	Form
Truck Driver Opinion Survey Attachment B - Truck Driver Opinion Survey.docx	Form
Exit Survey_Spanish Attachment D-Exit Survey_Spanish.docx	Form
Exit Survey_English Translation Attachment E-Exit Survey_English Translation.docx	Form
Attachment A - Protocol Summary.docx Attachment A - Protocol Summary	IC Document
Attachment B - Protocol Detail.docx Attachment B - Protocol Detail	IC Document
HMTS Expedited Review Form 112812.pdf HMTS Expedited Review Form 112812	IC Document
List of Attachments.docx List of Attachments	IC Document
Attachment A - Background Information.docx Attachment A - Background Information	IC Document
NIOSH Hitchcock HMTS Expedited Review Form 110612.pdf NIOSH Hitchcock HMTS Expedited Review Form 110612	IC Document
List of Attachments.docx List of Attachments	IC Document
HMTS Expedited Review Form 120312.pdf HMTS Expedited Review Form 120312	IC Document
List of Attachments.docx List of Attachments	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Msg Testing for (3) Expedited Reviews--Detonation of an Improv Nuc Devise (Span), AND Impact of a Truck Driver Pub Hth Prac Proj, AND Dissemination of Occup Safety & Hlth Materials thru Mex Consul

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Attachment D - Moderator's Guide.docx	Yes	Yes	Printable Only
Form	none	Screening Instrument	Attachment C - Screening Instrument.docx	Yes	Yes	Fillable Printable
Instruction			Attachment E - Participant Information Sheet.docx	Yes	Yes	Paper Only
Other-Screen shots			Attachment C- Screen Shots.pdf	Yes	Yes	Printable Only
Other-video			Attachment D - Sleep Debt PSA_30 seconds.mp3	Yes	Yes	Printable Only
Other-video			Attachment F - Whole World Changes PSA_60 seconds.mp3	Yes	Yes	Printable Only
Other-video			Attachment E - Whole World Changes PSA_30 seconds.mp3	Yes	Yes	Printable Only
Form	none	Truck Driver Opinion Survey	Attachment B - Truck Driver Opinion Survey.docx	Yes	Yes	Fillable Printable
Other-Recruitment Script_Spanish			Attachment B-Recruitment Script_Spanish.docx	Yes	Yes	Printable Only
Other-Recruitment Script_English Translation			Attachment C-Recruitment Script_English Translation.docx	Yes	Yes	Printable Only
Form	none	Exit Survey_Spanish	Attachment D-Exit Survey_Spanish.docx	Yes	Yes	Printable Only
Other-Test			FinalScript_English_051812.doc	Yes	Yes	Printable Only
Form	none	Exit Survey_English Translation	Attachment E-Exit Survey_English Translation.docx	Yes	Yes	Printable Only
Other-Test			FinalScript_Spanish_051812.doc	Yes	Yes	Printable Only
Other-Test document			GeneralTest113012v01.pdf	Yes	Yes	Printable Only
Other-Testing document			HotelTest113012v01.pdf	Yes	Yes	Printable Only
Other-Testing document			SoftskillsTest120312v01.pdf	Yes	Yes	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 644

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	644	0	0	0	0	0
Annual IC Time Burden (Hours)	199	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
Attachment A - Protocol Summary	Attachment A - Protocol Summary.docx	12/14/2012
Attachment B - Protocol Detail	Attachment B - Protocol Detail.docx	12/14/2012
HMTS Expedited Review Form 112812	HMTS Expedited Review Form 112812.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012
Attachment A - Background Information	Attachment A - Background Information.docx	12/14/2012
NIOSH Hitchcock HMTS Expedited Review Form 110612	NIOSH Hitchcock HMTS Expedited Review Form 110612.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012
HMTS Expedited Review Form 120312	HMTS Expedited Review Form 120312.pdf	12/14/2012
List of Attachments	List of Attachments.docx	12/14/2012

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