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⚠️ Notice: This information collection may be referencing outdated material.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_BDSTEPS_OCC_EEO_Nov302015.pdf Form
Cosmetology Questionnaire AttH3_BDSTEPS_OCC_Hairstylist_Nov302015.pdf Form
Healthcare Questionnaire AttH4_OCC_Healthcare.pdf Form
Housekeeping Questionnaire AttH5_BDSTEPS_OCC_Janitorial_Nov302015.pdf Form
Office Work Questionnaire AttH6_BDSTEPS_OCC_OfficeWorker_Nov302015.pdf Form
Restaurant Work Questionnaire AttH7_OCC_Restaurant.pdf Form
Teacher Questionnaire AttH8_OCC_Teacher.pdf Form
AttHS1_BDSTEPS_OCC_Agriculture_Spanish.pdf Screenshot - agriculture IC Document
AttHS2_BDSTEPS_OCC_EEO_Spanish.pdf Screenshot - EEO IC Document
AttHS3_BDSTEPS_OCC_Hairstylist_Spanish.pdf Screenshot - hairstylist IC Document
AttHS4_BDSTEPS_OCC_Healthcare_Spanish.pdf Screenshot - healthcare IC Document
AttHS5_BDSTEPS_OCC_Janitorial_Spanish.pdf Screenshot - janitorial IC Document
AttHS6_BDSTEPS_OCC_OfficeWorker_Spanish.pdf Screenshot - office worker IC Document
AttHS7_BDSTEPS_OCC_Restaurant_Spanish.pdf Screenshot - restaurant IC Document
AttHS8_BDSTEPS_OCC_Teacher_Spanish.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: Modified

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_BDSTEPS_OCC_EEO_Nov302015.pdf	Yes	Yes	Fillable Fileable
Form	none	Cosmetology Questionnaire	AttH3_BDSTEPS_OCC_Hairstylist_Nov302015.pdf	Yes	Yes	Fillable Fileable
Form	none	Healthcare Questionnaire	AttH4_OCC_Healthcare.pdf	Yes	Yes	Fillable Fileable
Form	none	Housekeeping Questionnaire	AttH5_BDSTEPS_OCC_Janitorial_Nov302015.pdf	Yes	Yes	Fillable Fileable
Form	none	Office Work Questionnaire	AttH6_BDSTEPS_OCC_OfficeWorker_Nov302015.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: 790	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	Previously Approved
Annual Number of Responses for this IC	790	148	642
Annual IC Time Burden (Hours)	263	49	214
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Screenshot - agriculture	AttHS1_BDSTEPS_OCC_Agriculture_Spanish.pdf	08/02/2016
Screenshot - EEO	AttHS2_BDSTEPS_OCC_EEO_Spanish.pdf	08/02/2016
Screenshot - hairstylist	AttHS3_BDSTEPS_OCC_Hairstylist_Spanish.pdf	08/02/2016
Screenshot - healthcare	AttHS4_BDSTEPS_OCC_Healthcare_Spanish.pdf	08/02/2016
Screenshot - janitorial	AttHS5_BDSTEPS_OCC_Janitorial_Spanish.pdf	08/02/2016
Screenshot - office worker	AttHS6_BDSTEPS_OCC_OfficeWorker_Spanish.pdf	08/02/2016
Screenshot - restaurant	AttHS7_BDSTEPS_OCC_Restaurant_Spanish.pdf	08/02/2016
Screenshot - teacher	AttHS8_BDSTEPS_OCC_Teacher_Spanish.pdf	08/02/2016

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