Shoulder Rating Questionnaire (SRQ)

Interventions to Reduce Shoulder MSDs in Overhead Assembly

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0964 can be found here:

Documents and Forms

Document Name Document Type
Shoulder Rating Questionnaire (SRQ) Form
SRQ Attachment G2 Shoulder Rating Questionnaire.8.13.12docx.docx Form

Information Collection (IC) Details

IC Title:	Shoulder Rating Questionnaire (SRQ)	Agency IC Tracking Number:

Is this a Common Form? No		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	none	SRQ	Attachment G2 Shoulder Rating Questionnaire.8.13.12docx.docx		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: 09-20-0118 Study at Work Sites Where Agents Suspected of Being Occupational Hazards Exist	FR Citation: 51 FR 42469

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 Agency Discretion
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.