Characterization of Haul Truck Health and Safety Issues

CDC/ATSDR Formative Research and Tool Development

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-20IU Characterization of Haul Truck Health and Safety Issues Form and Instruction
0920-20IU Cognitive Task Analysis (CTA) Interview Guide Attachment-B-CTA-InterviewGuide.docx Form and Instruction
0920-20IU Critical Decision Method (CDM) Semi-Structured Interview Attachment-C-CDM-InterviewGuide.docx Form and Instruction
Attachment-A-Authorizing-Legislation-FederalMineSafety&HealthAct1977.pdf Authorizing Legislation IC Document
Attachment-G-IRB-Approval-Letter.pdf IRB Approval IC Document
GenICRequest-HaulTruck_2-10-2020.docx GEN IC Request for Approval IC Document
Supporting-Statement-A_2-12-2020.docx SSA IC Document
Supporting-Statement-B-HaulTruck_2-12-2020.docx SSB IC Document
Attachment-F-InformedConsent.docx Informed Consent IC Document
Attachment-D-MiningCompanyRepRecruitmentScript.docx Informed Consent IC Document
Attachment-E-HaulTruckOperatorRecruitmentScript.docx RECRUITMENT SCRIPT – FOR HAUL TRUCK OPERATOR RESPONDENTS IC Document

Information Collection (IC) Details

IC Title:	Characterization of Haul Truck Health and Safety Issues	Agency IC Tracking Number:	0920-20IU

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20IU	Cognitive Task Analysis (CTA) Interview Guide	Attachment-B-CTA-InterviewGuide.docx		Yes	Yes	Fillable Fileable
Form and Instruction	0920-20IU	Critical Decision Method (CDM) Semi-Structured Interview Guide	Attachment-C-CDM-InterviewGuide.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	120	120
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation	Attachment-A-Authorizing-Legislation-FederalMineSafety&HealthAct1977.pdf	04/13/2020
IRB Approval	Attachment-G-IRB-Approval-Letter.pdf	04/13/2020
GEN IC Request for Approval	GenICRequest-HaulTruck_2-10-2020.docx	04/13/2020
SSA	Supporting-Statement-A_2-12-2020.docx	04/13/2020
SSB	Supporting-Statement-B-HaulTruck_2-12-2020.docx	04/13/2020
Informed Consent	Attachment-F-InformedConsent.docx	04/13/2020
Informed Consent	Attachment-D-MiningCompanyRepRecruitmentScript.docx	04/13/2020
RECRUITMENT SCRIPT – FOR HAUL TRUCK OPERATOR RESPONDENTS	Attachment-E-HaulTruckOperatorRecruitmentScript.docx	04/13/2020

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