OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

ICR 202110-0920-005 · OMB 0920-1350 · Public filing

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920- Serological Sample Form Unchanged Available
Form 0920- Att D18- Serological Sample Form Unchanged Available
Form 0920- Civil Unrest Form Unchanged Available
Form 0920- Att D17- Civil Unrest Form Unchanged Repair queued
Form 0920- COVID- Round2 Form Unchanged Available
Form 0920- Att D16- COVID19- Round 2 Form Unchanged Repair queued
Form 0920- COVID- Round 2 Form Unchanged Available
Form 0920- Att D15- COVID- Round 1 Form Unchanged Available
Form 0920- Beck Hopelessness Form Unchanged Available
Form 0920- Att D14- Beck Hopelessness Form Unchanged Repair queued
Form 0920- Att D13- Beck Depression Form Unchanged Available
Form 0920- Att D13- Beck Depression Form Unchanged Available
Form 0920- Pittsburgh Sleep Quality Index Form Unchanged Available
Form 0920- Att D12- Pittsburgh Sleep Quality Index Form Unchanged Available
Form 0920- Beck Anxiety Form Unchanged Available
Form 0920- Att D11- Beck Anxiety Form Unchanged Repair queued
Form 0920 Connoe Scale Form Unchanged Available
Form 0920 Att D10- Connor-Davidson Resiliency Scale Form Unchanged Repair queued
Form 0920 Posttraumatic Stress Disorder -5 Form Unchanged Available
Form 0920 Att D9- PTSD Form Unchanged Repair queued
Form 0920 Fatigue Scale Form Unchanged Available
Form 0920 Att D8- Fatigue Scale Form Unchanged Repair queued
Form 0920- Maslach Burnout Form Unchanged Available
Form 0920- Att D7- Maslach Burnout Form Unchanged Repair queued
Form 0920 Organizational Support Scale Form Unchanged Available
Form 0920 Att D6- Org Support Form Unchanged Repair queued
Form 0920- Brief Cope Form Unchanged Available
Form 0920- Att D5_Brief Cope Form Unchanged Repair queued
Form 0920- Centers for Epidemiological Studies Depression Form Unchanged Available
Form 0920- Att D4- Centers for Epidemiologic Studies Depression Scale Form Unchanged Repair queued
Form 0920- Eligibility Screening Form Unchanged Available
Form 0920- Att H1_Eligibility Screening Form Unchanged Repair queued
Form 0920- Spielberger Stress Survey Form Unchanged Available
Form 0920- Att D3- Spielberger Stress Survey Form Unchanged Repair queued
Form 0920 Medical History Form Unchanged Available
Form 0920 Att D2- Medical History Form Unchanged Repair queued
Form 0920 Personal History Form Unchanged Repair queued
Form 0920 Att D1- Personal History Form Unchanged Repair queued
Change Request Memo 12OCT2021.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-10-12 Repair queued
Appendix F2 NIOSH HSRB_non_exempt.pdf Supplementary Document Uploaded 2021-07-28 Repair queued
Appendix F1 UB IRB.docx Supplementary Document Uploaded 2021-07-28 Repair queued
Appendix E UB Consent Form.docx Supplementary Document Uploaded 2021-07-28 Repair queued
Appendix C Examination Components.docx Supplementary Document Uploaded 2021-07-02 Repair queued
Appendix B _60dy2121CG.FRN.pdf Supplementary Document Uploaded 2021-07-02 Repair queued
Appendix A.docx Supplementary Document Uploaded 2021-07-02 Repair queued
Statement B_revised 092921.docx Supporting Statement B Uploaded 2021-10-12 Repair queued
Statement A_revised 92921.docx Supporting Statement A Uploaded 2021-10-12 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
248601 Att D19- Salivary Cortisol collection Other- Unchanged
248600 Att D18- Serological Sample Form UnchangedSerological Sample
248600 Att D18- Serological Sample Form Unchanged
248599 Att D17- Civil Unrest Form UnchangedCivil Unrest
248599 Att D17- Civil Unrest Form Unchanged
248598 Att D16- COVID19- Round 2 Form UnchangedCOVID- Round2
248598 Att D16- COVID19- Round 2 Form Unchanged
248597 Att D15- COVID- Round 1 Form UnchangedCOVID- Round 2
248597 Att D15- COVID- Round 1 Form Unchanged
248596 Att D14- Beck Hopelessness Form UnchangedBeck Hopelessness
248596 Att D14- Beck Hopelessness Form Unchanged
248595 Att D13- Beck Depression Form UnchangedAtt D13- Beck Depression
248595 Att D13- Beck Depression Form Unchanged
248594 Att D12- Pittsburgh Sleep Quality Index Form UnchangedPittsburgh Sleep Quality Index
248594 Att D12- Pittsburgh Sleep Quality Index Form Unchanged
248592 Att D11- Beck Anxiety Form UnchangedBeck Anxiety
248592 Att D11- Beck Anxiety Form Unchanged
248589 Att D10- Connor-Davidson Resiliency Scale Form UnchangedConnoe Scale
248589 Att D10- Connor-Davidson Resiliency Scale Form Unchanged
248588 Att D9- PTSD Form UnchangedPosttraumatic Stress Disorder -5
248588 Att D9- PTSD Form Unchanged
248587 Att D8- Fatigue Scale Form UnchangedFatigue Scale
248587 Att D8- Fatigue Scale Form Unchanged
248586 Att D7- Maslach Burnout Form UnchangedMaslach Burnout
248586 Att D7- Maslach Burnout Form Unchanged
248585 Att D6- Org Support Form UnchangedOrganizational Support Scale
248585 Att D6- Org Support Form Unchanged
248582 Att D5_Brief Cope Form UnchangedBrief Cope
248582 Att D5_Brief Cope Form Unchanged
248581 Att D4- Centers for Epidemiologic Studies Depression Scale Form UnchangedCenters for Epidemiological Studies Depression
248581 Att D4- Centers for Epidemiologic Studies Depression Scale Form Unchanged
248580 Att H1_Eligibility Screening Form UnchangedEligibility Screening
248580 Att H1_Eligibility Screening Form Unchanged
248579 Att H_Introduction Letter Other-word Unchanged
248575 Att G_Letter of Invitation Other-WORD Unchanged
248340 Att D3- Spielberger Stress Survey Form UnchangedSpielberger Stress Survey
248340 Att D3- Spielberger Stress Survey Form Unchanged
248339 Att D2- Medical History Form UnchangedMedical History
248339 Att D2- Medical History Form Unchanged
248338 Att D1- Personal History Form UnchangedPersonal History
248338 Att D1- Personal History Form Unchanged

ICR Details

Record metadata
OMB Control No0920-1350