Information Collection

Occupational Questionnaires

IC 216968 under ICR 202212-0920-015 · OMB 0920-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0010 can be found here:

2025-05-01 - No material or nonsubstantive change to a currently approved collection
2024-05-07 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
Occupational Questionnaires Form and Instruction
Agriculture_Screenshots_English AttF1.1a_OOQ_Agriculture.pdf Form and Instruction
Agriculture_Screenshots_English AttF1.1a_OOQ_Agriculture.pdf Form and Instruction
Agriculture_Screenshots_Spanish AttF1.1b_OOQ_Agriculture.pdf Form and Instruction
Agriculture_Screenshots_Spanish AttF1.1b_OOQ_Agriculture.pdf Form and Instruction
Cosmetology_Screenshots_English AttF1.2a_OOQ_Cosmetology.pdf Form and Instruction
Cosmetology_Screenshots_English AttF1.2a_OOQ_Cosmetology.pdf Form and Instruction
Cosmetology_Screenshots_Spanish AttF1.2b_OOQ_Cosmetology.pdf Form and Instruction
Cosmetology_Screenshots_Spanish AttF1.2b_OOQ_Cosmetology.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_English AttF1.3a_OOQ_Electronic_Equipment_Operator.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_English AttF1.3a_OOQ_Electronic_Equipment_Operator.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_Spanish AttF1.3b_OOQ_Electronic_Equipment_Operator.pdf Form and Instruction
Electronic Equipment Operators_Screenshots_Spanish AttF1.3b_OOQ_Electronic_Equipment_Operator.pdf Form and Instruction
Healthcare_Screenshots_English AttF1.4a_OOQ_Healthcare.pdf Form and Instruction
Healthcare_Screenshots_English AttF1.4a_OOQ_Healthcare.pdf Form and Instruction
Healthcare_Screenshots_Spansih AttF1.4b_OOQ_Healthcare.pdf Form and Instruction
Healthcare_Screenshots_Spansih AttF1.4b_OOQ_Healthcare.pdf Form and Instruction
Janitorial_Screenshots_English AttF1.5a_OOQ_Janitorial.pdf Form and Instruction
Janitorial_Screenshots_English AttF1.5a_OOQ_Janitorial.pdf Form and Instruction
Janitorial_Screenshots_Spanish AttF1.5b_OOQ_Janitorial.pdf Form and Instruction
Janitorial_Screenshots_Spanish AttF1.5b_OOQ_Janitorial.pdf Form and Instruction
Office Worker_Screenshots_English AttF1.6a_OOQ_Office_Worker.pdf Form and Instruction
Office Worker_Screenshots_English AttF1.6a_OOQ_Office_Worker.pdf Form and Instruction
Office Worker_Screenshots_Spanish AttF1.6b_OOQ_Office_Worker.pdf Form and Instruction
Office Worker_Screenshots_Spanish AttF1.6b_OOQ_Office_Worker.pdf Form and Instruction
Restaurant Worker_Screenshots_English AttF1.7a_OOQ_Restaurant.pdf Form and Instruction
Restaurant Worker_Screenshots_English AttF1.7a_OOQ_Restaurant.pdf Form and Instruction
Restaurant Worker_Screenshots_Spanish AttF1.7b_OOQ_Restaurant.pdf Form and Instruction
Restaurant Worker_Screenshots_Spanish AttF1.7b_OOQ_Restaurant.pdf Form and Instruction
Teaching_Screenshots_English AttF1.8a_OOQ_Teaching.pdf Form and Instruction
Teaching_Screenshots_English AttF1.8a_OOQ_Teaching.pdf Form and Instruction
Teaching_Screenshots_Spanish AttF1.8b_OOQ_Teaching.pdf Form and Instruction
Teaching_Screenshots_Spanish AttF1.8b_OOQ_Teaching.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Occupational Questionnaires	Agency IC Tracking Number:	0920-0010

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	Agriculture_Screenshots_English	AttF1.1a_OOQ_Agriculture.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Agriculture_Screenshots_Spanish	AttF1.1b_OOQ_Agriculture.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Cosmetology_Screenshots_English	AttF1.2a_OOQ_Cosmetology.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Cosmetology_Screenshots_Spanish	AttF1.2b_OOQ_Cosmetology.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Electronic Equipment Operators_Screenshots_English	AttF1.3a_OOQ_Electronic_Equipment_Operator.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Electronic Equipment Operators_Screenshots_Spanish	AttF1.3b_OOQ_Electronic_Equipment_Operator.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Healthcare_Screenshots_English	AttF1.4a_OOQ_Healthcare.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Healthcare_Screenshots_Spansih	AttF1.4b_OOQ_Healthcare.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Janitorial_Screenshots_English	AttF1.5a_OOQ_Janitorial.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Janitorial_Screenshots_Spanish	AttF1.5b_OOQ_Janitorial.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Office Worker_Screenshots_English	AttF1.6a_OOQ_Office_Worker.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Office Worker_Screenshots_Spanish	AttF1.6b_OOQ_Office_Worker.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Restaurant Worker_Screenshots_English	AttF1.7a_OOQ_Restaurant.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Restaurant Worker_Screenshots_Spanish	AttF1.7b_OOQ_Restaurant.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Teaching_Screenshots_English	AttF1.8a_OOQ_Teaching.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Teaching_Screenshots_Spanish	AttF1.8b_OOQ_Teaching.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	0	830
Annual IC Time Burden (Hours)	277	0	277
Annual IC Cost Burden (Dollars)	0	-2,764	2,764

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.