OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

[NIOSH] Information Collection Provisions in 42 CFR Part 84 - Tests and Requirements for Certification and Approval of Respiratory Protective Devices

ICR 202311-0920-004 · OMB 0920-0109 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0109 Att 4_Standard Application Form Form Modified Repair queued
Form 0920-0109 Att 24 Test 118 Form New Repair queued
Form ETB 1211A Rev 1 FP Att 26 Wearability Test Form New Repair queued
Form 0920-0109 Att 25 Test 147 Form New Repair queued
Form ETB-1214 Rev 1 FPW Att 23 Stressors Form New Available
Form ETB-1014-APR -0030 Att 22 Sound Level STP-30_STP 111 Form New Repair queued
Form TEB-1214A Rev 0 Att 21 Performance Test Form New Missing upstream
Form TEB-1107 Rev 0 Att 20 LRPL Bitrex Donning Form New Repair queued
Form TEB-1107 Rev 0 Att 19 Fogging test Form New Repair queued
Form ETB-1028 Rev 5 Att 18 Fit Test STP -9 and 10 Form New Repair queued
Form TEB-1023 Rev.1 Att 17 Fit Test STP 5_5.1_6 Form New Repair queued
Form 0920-0109 Att 16 Donning Test Form New Repair queued
Form 0920-0109 Att 15 Communication Test Form New Repair queued
Form 0920-0109 Att 14 Capacity Test Form New Repair queued
Form 0920-0109 Att 13 Data Collection Form (Man testing) Form New Missing upstream
Form Form ETB-1035 Rev Att 12 Health and Wellness Screent (each test, fit testing) Form New Repair queued
Form 0920-0109 Att 11Pre-test Questionnaire for Respirator Fit Testing Form New Missing upstream
Form 0920-0109 Att 10 OSHA/NPPTL Medical Evaluation: Annually for all Test Participants_Rev 1 (10.25.2023) Form New Repair queued
Form 0920-0109 Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination Form New Repair queued
Form 0920-0109 Att 8_Test Participant Information Sheet Form New Repair queued
Form 0920-0109 Att 7c_Site audits,Site audits (completed for each corrective action) Form New Repair queued
Form 0920-0109 Att 7b_Site audits, Part 2_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form New Repair queued
Form 0920-0109 Att 5_Request manufacturing code Form and Instruction New Repair queued
Form 0920-0109 Att 7_Site audits, Part 1_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form Modified Repair queued
Atch_6_IRB determination.pdf Supplementary Document Uploaded 2020-10-07 Repair queued
Atch_3_60-day Federal Register Notice.pdf Supplementary Document Uploaded 2023-11-06 Repair queued
Atch_2_42 CFR part 84.docx Supplementary Document Uploaded 2020-10-07 Repair queued
Atch_1_OSH Act.docx Supplementary Document Uploaded 2020-10-07 Available
SupportingStatement_B_23November_1.docx Supporting Statement B Uploaded 2023-11-15 Repair queued
SupportingStatement_A_23November_1.docx Supporting Statement A Uploaded 2023-11-15 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
6639 Att 4_Standard Application Form Form Modified
263434 Att 24 Test 118 Form New
263433 Att 26 Wearability Test Form New
263430 Att 25 Test 147 Form New
263429 Att 23 Stressors Form New
263426 Att 22 Sound Level STP-30_STP 111 Form New
263425 Att 21 Performance Test Form New
263424 Att 20 LRPL Bitrex Donning Form New
263423 Att 19 Fogging test Form New
263422 Att 18 Fit Test STP -9 and 10 Form New
263421 Att 17 Fit Test STP 5_5.1_6 Form New
263417 Att 16 Donning Test Form New
263416 Att 15 Communication Test Form New
263413 Att 14 Capacity Test Form New
263412 Att 13 Data Collection Form (Man testing) Form New
263411 Att 12 Health and Wellness Screent (each test, fit testing) Form New
263410 Att 11Pre-test Questionnaire for Respirator Fit Testing Form New
263408 Att 10 OSHA/NPPTL Medical Evaluation: Annually for all Test Participants_Rev 1 (10.25.2023) Form New
263389 Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination Form New
263388 Att 8_Test Participant Information Sheet Form New
263230 Att 7c_Site audits,Site audits (completed for each corrective action) Form New
263229 Att 7b_Site audits, Part 2_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form New
263228 Att 5_Request manufacturing code Form and Instruction New
197842 Att 7_Site audits, Part 1_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form Modified
ICR Details
StatusReceived in OIRA
Agency/SubagencyHHS/CDC
OMB Control No0920-0109
Type of Information CollectionRevision of a currently approved collection
Previous ICR Reference No202009-0920-023
Agency Tracking No0920-0109
Date Submitted to OIRA1969-12-31
Requested Expiration Date1969-12-31