Heat-related Changes in Cognitive Performance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920 Bor and Thermail Sensaton Scale	Form	New	Available
Form 0920 Borg and Thermal Scale (M/FF/CW)	Form	New	Repair queued
Form 0920 Release of Information (HIPAA Privacy Authorization Form)	Form	New	Available
Form 0920 Release of Information (HIPPA) (M/FF/CW)	Form	New	Repair queued
Form 0920 Health-related changes in cognitive performance Environmental chamber component	Form and Instruction	New	Repair queued
Form 0920 Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	New	Repair queued
Form 0920- Health-related changes in cognitive performance - Field component	Form and Instruction	New	Available
Form 0920- Appx L_Consent Form Field Study (M)	Form and Instruction	New	Repair queued
PIA form.pdf	Supplementary Document	Uploaded 2020-09-01	Available
Appendix B 60 day FRN.pdf	Supplementary Document	Uploaded 2020-08-11	Repair queued
Appendix A Federal Mine Safety and Health Act.docx	Supplementary Document	Uploaded 2020-08-11	Repair queued
SSB (SMRD_Heat stres)_Part B_6.15.20.docx	Supporting Statement B	Uploaded 2020-08-11	Repair queued
SSA (SMRD_Heat stress)_Part A_6.15.20.docx	Supporting Statement A	Uploaded 2020-08-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
243426	Cognitive test: N-back -- no form (M/FF/CW)	Instruction	New
243425	PVT Cognitive Test - Field (M/FF/CW)	Instruction	New
243424	Borg and Thermal Scale (M/FF/CW)	Form	New	Bor and Thermail Sensaton Scale
243424	Borg and Thermal Scale (M/FF/CW)	Form	New
243423	Release of Information (HIPPA) (M/FF/CW)	Form	New	Release of Information (HIPAA Privacy Authorization Form)
243423	Release of Information (HIPPA) (M/FF/CW)	Form	New
243422	Fingerstick blood sample for point of care testing	Instruction	New
243421	Fitting of Chest Strap (M/FF/CW)	Instruction	New
243420	Ingestion of Temperature Pill (M/FF/CW)	Instruction	New
243419	PVT Cognitive Test - Field (M)	Instruction	New
243413	Fitting of Chest Strap (M)	Instruction	New
243412	Ingestion of Temperature Pill (M)	Instruction	New
243410	Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	New	Health-related changes in cognitive performance Environmental chamber component
243410	Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	New
243407	Appx L_Consent Form Field Study (M)	Form and Instruction	New	Health-related changes in cognitive performance - Field component
243407	Appx L_Consent Form Field Study (M)	Form and Instruction	New
243405	Appx I_ Pre-Test Questionnaire (M/FF/CW)	Other-App (WORD)	New
243404	Appx H_PANAS sleepiness fatigue (M/FF/CW)	Other-WORD	New
243403	Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Other-App	New
243402	Appx F_Physcal Examination (M/FF/CW)	Other-WORD	New
243135	Appx E - Heat stress app - post-shift questionnaire (field) (M)	Other-App (WORD)	New
243132	Appx D - Heat Stress app -- shift questionnaire for field (M)	Other-App	New
243129	Appx C - Health screening questionnaire - Field app (M)	Other-App	New

ICR Details

OMB Control No: 0920-1331	ICR Reference No: 202008-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20HO
Title: Heat-related Changes in Cognitive Performance
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/24/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/02/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2024	36 Months From Approved
Responses	936	0	0
Time Burden (Hours)	103	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The purpose of this study is to collect information on burden of heat strain among miners as well as factors related to personal risk and core body temperature that contribute to individual variability in heat tolerance and to declines in heat-related worker performance. The proposed program is a step toward meeting NIOSH and industry goals in addressing heat strain among miners. To prioritize future occupational safety and health research and prevention activities in each major industry sector, NIOSH organized national sector councils comprised of representatives from NIOSH, industry, organized labor, and academia. The Mining Sector Council (MSC) identified critical knowledge gaps and research needs in its National Mining Agenda in 2015.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10697	02/25/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 51439	08/20/2020
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Appx C - Health screening questionnaire - Field app (M)
Appx D - Heat Stress app -- shift questionnaire for field (M)
Appx E - Heat stress app - post-shift questionnaire (field) (M)
Appx F_Physcal Examination (M/FF/CW)
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)
Appx H_PANAS sleepiness fatigue (M/FF/CW)
Appx I_ Pre-Test Questionnaire (M/FF/CW)
Appx L_Consent Form Field Study (M)	0920-	Health-related changes in cognitive performance - Field component
Appx M_ Consent Form Environment Chamber (M/FF/CW)	0920	Health-related changes in cognitive performance Environmental chamber component
Borg and Thermal Scale (M/FF/CW)	0920	Bor and Thermail Sensaton Scale
Cognitive test: N-back -- no form (M/FF/CW)
Fingerstick blood sample for point of care testing
Fitting of Chest Strap (M)
Fitting of Chest Strap (M/FF/CW)
Ingestion of Temperature Pill (M)
Ingestion of Temperature Pill (M/FF/CW)
PVT Cognitive Test - Field (M)
PVT Cognitive Test - Field (M/FF/CW)
Release of Information (HIPPA) (M/FF/CW)	0920	Release of Information (HIPAA Privacy Authorization Form)

---

ICR Summary of Burden

table that charts list 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	936	0	0	786	150	0
Annual Time Burden (Hours)	103	0	0	88	15	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a NEW information collection request.

---

Annual Cost to Federal Government: $452,560

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     Yes

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.     Yes

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? No

---

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: 09/02/2020

---