[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

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-0109 Att 4_Standard Application Form Form	Modified
Form 0920-0109 Att 24 Test 118 Form	New
Form ETB 1211A Rev 1 FP Att 26 Wearability Test Form	New
Form 0920-0109 Att 25 Test 147 Form	New
Form ETB-1214 Rev 1 FPW Att 23 Stressors Form	New
Form ETB-1014-APR -0030 Att 22 Sound Level STP-30_STP 111 Form	New
Form TEB-1214A Rev 0 Att 21 Performance Test Form	New
Form TEB-1107 Rev 0 Att 20 LRPL Bitrex Donning Form	New
Form TEB-1107 Rev 0 Att 19 Fogging test Form	New
Form ETB-1028 Rev 5 Att 18 Fit Test STP -9 and 10 Form	New
Form TEB-1023 Rev.1 Att 17 Fit Test STP 5_5.1_6 Form	New
Form 0920-0109 Att 16 Donning Test Form	New
Form 0920-0109 Att 15 Communication Test Form	New
Form 0920-0109 Att 14 Capacity Test Form	New
Form 0920-0109 Att 13 Data Collection Form (Man testing) Form	New
Form Form ETB-1035 Rev Att 12 Health and Wellness Screent (each test, fit testing) Form	New
Form 0920-0109 Att 11Pre-test Questionnaire for Respirator Fit Testing Form	New
Form 0920-0109 Att 10 OSHA/NPPTL Medical Evaluation: Annually for all Test Participants_Rev 1 (10.25.2023) Form	New
Form 0920-0109 Att 9 Pre- and Post-Test Session Participant Questionnaire and Examination Form	New
Form 0920-0109 Att 8_Test Participant Information Sheet Form	New
Form 0920-0109 Att 7c_Site audits,Site audits (completed for each corrective action) Form	New
Form 0920-0109 Att 7b_Site audits, Part 2_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form	New
Form 0920-0109 Att 5_Request manufacturing code Form and Instruction	New
Form 0920-0109 Att 7_Site audits, Part 1_Respiratory Protective Devices-42 CFR part 84-Regulation (Audit) Form	Modified
Atch_6_IRB determination.pdf Supplementary Document	2020-10-07
Atch_3_60-day Federal Register Notice.pdf Supplementary Document	2023-11-06
Atch_2_42 CFR part 84.docx Supplementary Document	2020-10-07
Atch_1_OSH Act.docx Supplementary Document	2020-10-07
SupportingStatement_B_23November_1.docx Supporting Statement B	2023-11-15
SupportingStatement_A_23November_1.docx Supporting Statement A	2023-11-15

IC Document Collections

IC ID	Document Title	Status
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