Occupational Questionnaires

Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
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

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:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Agriculture Questionnaire	AttH1_OCC_Agriculture.pdf	Yes	Yes	Fillable Fileable
Form	none	Electronic Equipment Operator Questionnaire	AttH2_OCC_EEO.PDF	Yes	Yes	Fillable Fileable
Form	none	Cosmetology Questionnaire	AttH3_OCC_Hairstylist.pdf	Yes	Yes	Fillable Fileable
Form	none	Healthcare Questionnaire	AttH4_OCC_Healthcare.pdf	Yes	Yes	Fillable Fileable
Form	none	Housekeeping Questionnaire	AttH5_OCC_Janitorial.pdf	Yes	Yes	Fillable Fileable
Form	none	Office Work Questionnaire	AttH6_OCC_OfficeWorker.pdf	Yes	Yes	Fillable Fileable
Form	none	Restaurant Work Questionnaire	AttH7_OCC_Restaurant.pdf	Yes	Yes	Fillable Fileable
Form	none	Teacher Questionnaire	AttH8_OCC_Teacher.pdf	Yes	Yes	Fillable Fileable

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 %

	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

Title	Document	Date Uploaded
Screenshot - agriculture	BDSTEPS_OCC_Agriculture_Nov302015.pdf	12/01/2015
Screenshot - EEO	BDSTEPS_OCC_EEO_Nov302015.pdf	12/01/2015
Screenshot - hairstylist	BDSTEPS_OCC_Hairstylist_Nov302015.pdf	12/01/2015
Screenshot - healthcare	BDSTEPS_OCC_Healthcare_Nov302015.pdf	12/01/2015
Screenshot - janitorial	BDSTEPS_OCC_Janitorial_Nov302015.pdf	12/01/2015
Screenshot - office worker	BDSTEPS_OCC_OfficeWorker_Nov302015.pdf	12/01/2015
Screenshot - restaurant	BDSTEPS_OCC_Restaurant_Nov302015.pdf	12/01/2015
Screenshot - teacher	BDSTEPS_OCC_Teacher_Nov302015.pdf	12/01/2015

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