Document Name Document Type
Occupational Questionnaires Form and Instruction
Agriculture_Screenshots_English AttG1.1_BDSTEPS_OOQ_Agriculture.pdf Form and Instruction
Agriculture_Screenshots_Spanish AttG1.2_BDSTEPS_OOQ_Agriculture_SPAN.pdf Form and Instruction
Cosmetology_Screenshots_English AttG2.1_BDSTEPS_OOQ_Cosmetology.pdf Form and Instruction
Cosmetology_Screenshots_Spanish AttG2.2_BDSTEPS_OOQ_Cosmetology_SPAN.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_English AttG3.1_BDSTEPS_OOQ_EEO.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_Spanish AttG3.2_BDSTEPS_OOQ_EEO_SPAN.pdf Form and Instruction
Healthcare_Screenshots_English AttG4.1_BDSTEPS_OOQ_Healthcare.pdf Form and Instruction
Healthcare_Screenshots_Spansih AttG4.2_BDSTEPS_OOQ_Healthcare_SPAN.pdf Form and Instruction
Janitorial_Screenshots_English AttG5.1_BDSTEPS_OOQ_Janitorial.pdf Form and Instruction
Janitorial_Screenshots_Spanish AttG5.2_BDSTEPS_OOQ_Janitorial_SPAN.pdf Form and Instruction
Office Worker_Screenshots_English AttG6.1_BDSTEPS_OOQ_OfficeWorker.pdf Form and Instruction
Office Worker_Screenshots_Spanish AttG6.2_BDSTEPS_OOQ_OfficeWorker_SPAN.pdf Form and Instruction
Restaurant Worker_Screenshots_English AttG7.1_BDSTEPS_OOQ_Restaurant.pdf Form and Instruction
Restaurant Worker_Screenshots_Spanish AttG7.2_BDSTEPS_OOQ_Restaurant_SPAN.pdf Form and Instruction
Teaching_Screenshots_English AttG8.1_BDSTEPS_OOQ_Teaching.pdf Form and Instruction
Teaching_Screenshots_Spanish AttG8.2_BDSTEPS_OOQ_Teaching_SPAN.pdf Form and Instruction
AttG1.A1_BDSTEPS_OOQ_Agriculture-HC.pdf Agriculture Questionnaire Content_English IC Document
AttG1.B2_BDSTEPS_OOQ_Agriculture_-HC_SPAN.pdf Agriculture Questionnaire Content_Spanish IC Document
AttG2.A1_BDSTEPS_OOQ_Cosmetology-HC.pdf Cosmetology Questionnaire Content_English IC Document
AttG2.B2_BDSTEPS_OOQ_Cosmetology_-HC_SPAN.pdf Cosmetology Questionnaire Content_Spanish IC Document
AttG3.A1_BDSTEPS_OOQ_EEO-HC.pdf Electrical Equipment Operators Questionnaire Content_English IC Document
AttG3.B2_BDSTEPS_OOQ_EEO_-HC_SPAN.pdf Electrical Equipment Operators Questionnaire Content_Spanish IC Document
AttG4.A1_BDSTEPS_OOQ_Healthcare-HC.pdf Healthcare Workers Questionnaire Content_English IC Document
AttG4.B2_BDSTEPS_OOQ_Healthcare_-HC_SPAN.pdf Healthcare Workers Questionnaire Content_Spanish IC Document
AttG5.A1_BDSTEPS_OOQ_Janitorial-HC.pdf Janitorial Workers Questionnaire Content_English IC Document
AttG5.B2_BDSTEPS_OOQ_Janitorial_-HC_SPAN.pdf Janitorial Workers Questionnaire Content_Spanish IC Document
AttG6.A1_BDSTEPS_OOQ_OfficeWorker-HC.pdf Office Workers Questionnaire Content_English IC Document
AttG6.B2_BDSTEPS_OOQ_OfficeWorker_-HC_SPAN.pdf Office Workers Questionnaire Content_Spanish IC Document
AttG7.A1_BDSTEPS_OOQ_Restaurant-HC.pdf Restaurant Workers Questionnaire Content_English IC Document
AttG7.B2_BDSTEPS_OOQ_Restaurant_-HC_SPAN.pdf Restaurant Workers Questionnaire Content_Spanish IC Document
AttG8.A1_BDSTEPS_OOQ_Teaching-HC.pdf Teaching Questionnaire Content_English IC Document
AttG8.B2_BDSTEPS_OOQ_Teaching_-HC_SPAN.pdf Teaching Questionnaire Content_Spanish 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: 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 and Instruction	n/a	Janitorial_Screenshots_English	AttG5.1_BDSTEPS_OOQ_Janitorial.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Janitorial_Screenshots_Spanish	AttG5.2_BDSTEPS_OOQ_Janitorial_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Office Worker_Screenshots_English	AttG6.1_BDSTEPS_OOQ_OfficeWorker.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Office Worker_Screenshots_Spanish	AttG6.2_BDSTEPS_OOQ_OfficeWorker_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Restaurant Worker_Screenshots_English	AttG7.1_BDSTEPS_OOQ_Restaurant.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Restaurant Worker_Screenshots_Spanish	AttG7.2_BDSTEPS_OOQ_Restaurant_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Teaching_Screenshots_English	AttG8.1_BDSTEPS_OOQ_Teaching.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Teaching_Screenshots_Spanish	AttG8.2_BDSTEPS_OOQ_Teaching_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Agriculture_Screenshots_English	AttG1.1_BDSTEPS_OOQ_Agriculture.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Agriculture_Screenshots_Spanish	AttG1.2_BDSTEPS_OOQ_Agriculture_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Cosmetology_Screenshots_English	AttG2.1_BDSTEPS_OOQ_Cosmetology.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Cosmetology_Screenshots_Spanish	AttG2.2_BDSTEPS_OOQ_Cosmetology_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Electronic Equipment Operators_Screenshots_English	AttG3.1_BDSTEPS_OOQ_EEO.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Electronic Equipment Operators_Screenshots_Spanish	AttG3.2_BDSTEPS_OOQ_EEO_SPAN.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Healthcare_Screenshots_English	AttG4.1_BDSTEPS_OOQ_Healthcare.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Healthcare_Screenshots_Spansih	AttG4.2_BDSTEPS_OOQ_Healthcare_SPAN.pdf	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: 830	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	830	40	790
Annual IC Time Burden (Hours)	277	14	263
Annual IC Cost Burden (Dollars)	2,764	2,764	0

Documents for IC

Title	Document	Date Uploaded
Agriculture Questionnaire Content_English	AttG1.A1_BDSTEPS_OOQ_Agriculture-HC.pdf	08/26/2019
Agriculture Questionnaire Content_Spanish	AttG1.B2_BDSTEPS_OOQ_Agriculture_-HC_SPAN.pdf	08/26/2019
Cosmetology Questionnaire Content_English	AttG2.A1_BDSTEPS_OOQ_Cosmetology-HC.pdf	08/26/2019
Cosmetology Questionnaire Content_Spanish	AttG2.B2_BDSTEPS_OOQ_Cosmetology_-HC_SPAN.pdf	08/26/2019
Electrical Equipment Operators Questionnaire Content_English	AttG3.A1_BDSTEPS_OOQ_EEO-HC.pdf	08/26/2019
Electrical Equipment Operators Questionnaire Content_Spanish	AttG3.B2_BDSTEPS_OOQ_EEO_-HC_SPAN.pdf	08/26/2019
Healthcare Workers Questionnaire Content_English	AttG4.A1_BDSTEPS_OOQ_Healthcare-HC.pdf	08/26/2019
Healthcare Workers Questionnaire Content_Spanish	AttG4.B2_BDSTEPS_OOQ_Healthcare_-HC_SPAN.pdf	08/26/2019
Janitorial Workers Questionnaire Content_English	AttG5.A1_BDSTEPS_OOQ_Janitorial-HC.pdf	08/26/2019
Janitorial Workers Questionnaire Content_Spanish	AttG5.B2_BDSTEPS_OOQ_Janitorial_-HC_SPAN.pdf	08/26/2019
Office Workers Questionnaire Content_English	AttG6.A1_BDSTEPS_OOQ_OfficeWorker-HC.pdf	08/26/2019
Office Workers Questionnaire Content_Spanish	AttG6.B2_BDSTEPS_OOQ_OfficeWorker_-HC_SPAN.pdf	08/26/2019
Restaurant Workers Questionnaire Content_English	AttG7.A1_BDSTEPS_OOQ_Restaurant-HC.pdf	08/26/2019
Restaurant Workers Questionnaire Content_Spanish	AttG7.B2_BDSTEPS_OOQ_Restaurant_-HC_SPAN.pdf	08/26/2019
Teaching Questionnaire Content_English	AttG8.A1_BDSTEPS_OOQ_Teaching-HC.pdf	08/26/2019
Teaching Questionnaire Content_Spanish	AttG8.B2_BDSTEPS_OOQ_Teaching_-HC_SPAN.pdf	08/26/2019

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

Occupational Questionnaires

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

OMB: 0920-0010

IC ID: 216968

View Information Collection (IC)