Appx E - Heat stress app - post-shift questionnaire (field) (M)

Heat-related Changes in Cognitive Performance

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1331 can be found here:

Documents and Forms

Document Name Document Type
Appendix E Heat stress app post-shift questionnaire.docx Other-App (WORD)
Appendix E Heat stress app post-shift questionnaire.docx Other-App (WORD)

Information Collection (IC) Details

IC Title:	Appx E - Heat stress app - post-shift questionnaire (field) (M)	Agency IC Tracking Number:	0920-20HO

Is this a Common Form? No		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
Other-App (WORD)			Appendix E Heat stress app post-shift questionnaire.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	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
Annual Number of Responses for this IC	60	60
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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