1,3-Butadiene Standard (29 CFR 1910.1051)

Forms and Documents

Document Name	Status
Form 29 CFR 1910.1051 A 1,3-Butadiene (29 CFR 1910.1051) Form	Modified
SS_1218-0170_1-3 Butadiene 05-08-2019_SIPs IV ROCIS.docx Supporting Statement A	2019-05-08
OSH Act Section 8 USC 657.pdf Supplementary Document	2018-09-18
OSH Act Section 6 USC 655 (2).pdf Supplementary Document	2018-09-18
OSH Act Section 2 USC 651 (2).pdf Supplementary Document	2018-09-18

IC Document Collections

IC ID	Document Title	Status
14103	1,3-Butadiene (29 CFR 1910.1051) Form	Modified

ICR Details

OMB Control No: 1218-0170	ICR Reference No: 201809-1218-006
Status: Historical Active	Previous ICR Reference No: 201512-1218-004
Agency/Subagency: DOL/OSHA	Agency Tracking No: 1218-0170(2018)SIPIV
Title: 1,3-Butadiene Standard (29 CFR 1910.1051)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2019
	Date Received in OIRA: 05/14/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	6 Months From Approved	07/31/2019
Responses	3,649	0	3,649
Time Burden (Hours)	915	0	915
Cost Burden (Dollars)	112,808	0	112,808

---

Abstract: The purpose of this standard and its information collection requirements is to provide protection for workers from the adverse health effects associated with occupational exposure to 1,3-Butadiene.

---

Authorizing Statute(s): US Code: 29 USC 651 Name of Law: Occupational Safety and Health Act
   US Code: 29 USC 655 Name of Law: Occupational Safety and Health Act
   US Code: 29 USC 657 Name of Law: Occupational Safety and Health Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
1218-AC67	Final or interim final rulemaking	84 FR 21416	05/14/2019

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 68504	10/04/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 68504	10/04/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
1,3-Butadiene (29 CFR 1910.1051)	29 CFR 1910.1051 Appendix F	Medical Questionnaires (Non-Mandatory); 1,3 Butadiene Initial Health Questionnaire; 1,3-Butadiene Update Health Questionnaire

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,649	3,649	0	0	0	0
Annual Time Burden (Hours)	915	915	0	0	0	0
Annual Cost Burden (Dollars)	112,808	112,808	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/14/2019

---