Information Collection

Occupational Questionnaires

IC 216968 under ICR 201505-0920-009 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

2025-05-01 - No material or nonsubstantive change to a currently approved collection
2024-05-07 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Agriculture Questionnaire Occupational Questionnaires	Form
Electronic Equipment Operator Questionnaire Occupational Questionnaires	Form
Cosmetology Questionnaire Occupational Questionnaires	Form
Healthcare Questionnaire Occupational Questionnaires	Form
Housekeeping Questionnaire Occupational Questionnaires	Form
Office Work Questionnaire Occupational Questionnaires	Form
Restaurant Work Questionnaire Occupational Questionnaires	Form
Teacher Questionnaire Occupational Questionnaires	Form
Agriculture Questionnaire AttH1_OCC_Agriculture.pdf	Form
Electronic Equipment Operator Questionnaire AttH2_OCC_EEO.PDF	Form
Cosmetology Questionnaire AttH3_OCC_Hairstylist.pdf	Form
Healthcare Questionnaire AttH4_OCC_Healthcare.pdf	Form
Housekeeping Questionnaire AttH5_OCC_Janitorial.pdf	Form
Office Work Questionnaire AttH6_OCC_OfficeWorker.pdf	Form
Restaurant Work Questionnaire AttH7_OCC_Restaurant.pdf	Form
Teacher Questionnaire AttH8_OCC_Teacher.pdf	Form
BDSTEPS_OCC_Agriculture_Nov302015.pdf Screenshot - agriculture	IC Document
BDSTEPS_OCC_EEO_Nov302015.pdf Screenshot - EEO	IC Document
BDSTEPS_OCC_Hairstylist_Nov302015.pdf Screenshot - hairstylist	IC Document
BDSTEPS_OCC_Healthcare_Nov302015.pdf Screenshot - healthcare	IC Document
BDSTEPS_OCC_Janitorial_Nov302015.pdf Screenshot - janitorial	IC Document
BDSTEPS_OCC_OfficeWorker_Nov302015.pdf Screenshot - office worker	IC Document
BDSTEPS_OCC_Restaurant_Nov302015.pdf Screenshot - restaurant	IC Document
BDSTEPS_OCC_Teacher_Nov302015.pdf Screenshot - teacher	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Occupational Questionnaires

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	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable
Form	none	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 642

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 Agency Discretion
Annual Number of Responses for this IC	642	642
Annual IC Time Burden (Hours)	214	214
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screenshot - agriculture		12/01/2015
Screenshot - EEO		12/01/2015
Screenshot - hairstylist		12/01/2015
Screenshot - healthcare		12/01/2015
Screenshot - janitorial		12/01/2015
Screenshot - office worker		12/01/2015
Screenshot - restaurant		12/01/2015
Screenshot - teacher		12/01/2015

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

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