Noise and Hearing Questionnaire

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

Documents and Forms

Document Name Document Type
Form 0920-22DI Noise and Hearing Questionnaire Form and Instruction
0920-22DI Attachment C_Noise_and_Hearing_Questionnaire Attachment C_Noise_and_Hearing_Questionnaire.docx Form and Instruction
0920-22DI Attachment C_Noise_and_Hearing_Questionnaire Attachment C_Noise_and_Hearing_Questionnaire.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Noise and Hearing Questionnaire	Agency IC Tracking Number:	0920-22DI

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
Form and Instruction	0920-22DI	Attachment C_Noise_and_Hearing_Questionnaire	Attachment C_Noise_and_Hearing_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: 167	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	167	167
Annual IC Time Burden (Hours)	47	47
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.