[NIOSH] Heat-related Changes in Cognitive Performance

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1331 Exertion and Thermal Sensation Scale	Form	Modified	Available
Form 0920-1331 Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	Form	Modified	Repair queued
Form 0920-1331 Release of Information (HIPAA Privacy Authorization Form)	Form	Modified	Available
Form 0920-1331 Appx N_ Release of Information (HIPPA) (M/FF/CW)	Form	Modified	Repair queued
Form 0920-1331 Consent to be in a Research Study Health-related changes in cognitive performance	Form and Instruction	Modified	Available
Form 0920-1331 Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	Modified	Repair queued
Form 0920-1331 Consent to be in a Research Study Health-related changes in cognitive performance Field component.	Form and Instruction	Modified	Available
Form 0920-1331 Appx L Consent (Field component) _Miners	Form and Instruction	Modified	Repair queued
Form 0920-1331 Initial Participant Questionnaire: Chamber	Form	Modified	Available
Form 0920-1331 Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Form	Modified	Repair queued
Form 0920-1331 Physical Examination	Form	Modified	Available
Form 0920-1331 Appx F_Physcal Examination (M/FF/CW)	Form	Modified	Repair queued
Form 0920-1331 Initial Participant Questionnaire: Field	Form and Instruction	Modified	Available
Form 0920-1331 Appx C_Initial Participant Questionnaire: Field (Health screening)	Form and Instruction	Modified	Repair queued
Appendix Q IRB amendment approval.pdf	Supplementary Document	Uploaded 2024-02-07	Repair queued
PIA.pdf	Supplementary Document	Uploaded 2024-01-30	Repair queued
Appendix B 60 day FRN.pdf	Supplementary Document	Uploaded 2024-02-27	Repair queued
Appendix A Federal Mine Safety and Health Act.docx	Supplementary Document	Uploaded 2020-08-11	Repair queued
SMRD_Heat stress_SSB.docx	Supporting Statement B	Uploaded 2024-01-30	Repair queued
SSA_SMRD_Heat Stress_02-27-24.docx	Supporting Statement A	Uploaded 2024-02-27	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
243426	Cognitive test: N-back -- no form (M/FF/CW)	Instruction	Unchanged
243425	Consent - Research Study (PVT Cognitive Test) - Field (M/FF/CW)	Instruction	Modified
243424	Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	Form	Modified	Exertion and Thermal Sensation Scale
243424	Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	Form	Modified
243423	Appx N_ Release of Information (HIPPA) (M/FF/CW)	Form	Modified	Release of Information (HIPAA Privacy Authorization Form)
243423	Appx N_ Release of Information (HIPPA) (M/FF/CW)	Form	Modified
243422	Fingerstick blood sample for point of care testing	Instruction	Unchanged
243421	Fitting of Chest Strap (M/FF/CW)	Instruction	Unchanged
243420	Ingestion of Temperature Pill (M/FF/CW)	Instruction	Modified
243419	Appx K_Field Recruitment Script (PVT Cognitive Test) _Miner	Instruction	Modified
243413	Fitting of Chest Strap (M)	Instruction	Unchanged
243412	Consent Form - (Ingestion of Temperature Pill (M))	Instruction	Modified
243410	Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	Modified	Consent to be in a Research Study Health-related changes in cognitive performance
243410	Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction	Modified
243407	Appx L Consent (Field component) _Miners	Form and Instruction	Modified	Consent to be in a Research Study Health-related changes in cognitive performance Field component.
243407	Appx L Consent (Field component) _Miners	Form and Instruction	Modified
243405	Appx I_ Pre-Test Questionnaire (M/FF/CW)	Other-App (WORD)	Unchanged
243404	Appx H_PANAS sleepiness fatigue (M/FF/CW)	Other-WORD	Unchanged
243403	Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Form	Modified	Initial Participant Questionnaire: Chamber
243403	Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Form	Modified
243402	Appx F_Physcal Examination (M/FF/CW)	Form	Modified	Physical Examination
243402	Appx F_Physcal Examination (M/FF/CW)	Form	Modified
243135	Appx E -Pre-Shift Questionnaire on Heat Stress (App) Miners	Other-App (WORD)	Modified
243132	Appx D - Questionnaire on Heat Stress (App) Miners-- Shift for field	Other-App (WORD)	Modified
243129	Appx C_Initial Participant Questionnaire: Field (Health screening)	Form and Instruction	Modified	Initial Participant Questionnaire: Field
243129	Appx C_Initial Participant Questionnaire: Field (Health screening)	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1331	ICR Reference No: 202310-0920-010
Status: Active	Previous ICR Reference No: 202008-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1331
Title: [NIOSH] Heat-related Changes in Cognitive Performance
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/05/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/28/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2027	36 Months From Approved	04/30/2024
Responses	936	0	936
Time Burden (Hours)	103	0	103
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this study is to collect information on burden of heat strain among miners as well as factors related to personal risk and core body temperature that contribute to individual variability in heat tolerance and to declines in heat-related worker performance. The goal of the study is to assess the following: (1) whether a core body temperature threshold exists at which cognitive performance beings to decline, (2) factors that contribute to inter- and intra- individual variability in cognitive physiologic responses to heat, and (2) patterns of heat strain among miners in both surface and underground mines. The intended use for this data is to develop guidance and strategies to mitigate risk of heat strain among miners. This guidance will build on the strategies currently used by mining but will include information on how to incorporate personal factors and physiologic measurements into current heat strain monitoring and prevention practices.

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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 39433	06/16/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 14499	02/27/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 19

table that charts list of burden

IC Title	Form No.	Form Name
Appx C_Initial Participant Questionnaire: Field (Health screening)	0920-1331	Initial Participant Questionnaire: Field
Appx D - Questionnaire on Heat Stress (App) Miners-- Shift for field
Appx E -Pre-Shift Questionnaire on Heat Stress (App) Miners
Appx F_Physcal Examination (M/FF/CW)	0920-1331	Physical Examination
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	0920-1331	Initial Participant Questionnaire: Chamber
Appx H_PANAS sleepiness fatigue (M/FF/CW)
Appx I_ Pre-Test Questionnaire (M/FF/CW)
Appx K_Field Recruitment Script (PVT Cognitive Test) _Miner
Appx L Consent (Field component) _Miners	0920-1331	Consent to be in a Research Study Health-related changes in cognitive performance Field component.
Appx M_ Consent Form Environment Chamber (M/FF/CW)	0920-1331	Consent to be in a Research Study Health-related changes in cognitive performance
Appx N_ Release of Information (HIPPA) (M/FF/CW)	0920-1331	Release of Information (HIPAA Privacy Authorization Form)
Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	0920-1331	Exertion and Thermal Sensation Scale
Cognitive test: N-back -- no form (M/FF/CW)
Consent - Research Study (PVT Cognitive Test) - Field (M/FF/CW)
Consent Form - (Ingestion of Temperature Pill (M))
Fingerstick blood sample for point of care testing
Fitting of Chest Strap (M)
Fitting of Chest Strap (M/FF/CW)
Ingestion of Temperature Pill (M/FF/CW)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	936	936	0	0	0	0
Annual Time Burden (Hours)	103	103	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $452,560

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     Yes

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: 02/28/2024

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