[NIOSH] Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-22DI Audiometry Testing	Form and Instruction	New	Repair queued
Form 0920-22DI Informed Consent	Form and Instruction	New	Repair queued
Form 0920-22DI Noise and Hearing Questionnaire	Form and Instruction	New	Repair queued
Attachment B_60_day FRN.pdf	Supplementary Document	Uploaded 2023-08-30	Repair queued
NIOSH IRB Conditional Approval Report.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment J_Audiometric exam results notification letter.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment I_Exposure results notification letter.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment H_Sample forms.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment E_Fact sheet.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment D_Introductory recruitment letter.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Attachment A - Authorizing Legislation.docx	Supplementary Document	Uploaded 2023-08-23	Repair queued
Supporting Statement B_04-12-23.docx	Supporting Statement B	Uploaded 2023-08-23	Available
Supporting Statement A_04-12-23.docx	Supporting Statement A	Uploaded 2023-08-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261727	Audiometry Testing	Form and Instruction	New
261725	Informed Consent	Form and Instruction	New
261723	Noise and Hearing Questionnaire	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202308-0920-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22DI
Title: [NIOSH] Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/30/2023

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	367	0
Time Burden (Hours)	106	0
Cost Burden (Dollars)	0	0

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Abstract: The proposed data collection will provide an initial step toward achieving a prioritized activity goals identified by the National Occupational Research Agenda (NORA) for workers in the Oil and Gas sector, specifically addressing goals related to hearing loss. NORA is a partnership program designed to stimulate innovative research and improve workplace practices. Unveiled in 1996, NORA has become a research framework for NIOSH and the nation. Diverse parties (industry, academia, government, insurance, etc.) collaborate to identify the most critical issues in workplace safety and health.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 30750	05/12/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 56825	08/21/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Audiometry Testing	0920-22DI	Attachment G_Audiometry testing data capture
Informed Consent	0920-22DI	Consent
Noise and Hearing Questionnaire	0920-22DI	Attachment C_Noise_and_Hearing_Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	367	0	0	367	0	0
Annual Time Burden (Hours)	106	0	0	106	0	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 new collection seeks three years of approval for 106 annual burden hours.

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Annual Cost to Federal Government: $397,206

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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.     No

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

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Common Form ICR:  No

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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: 08/30/2023

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