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Att 8_Test Participant Information Sheet
[NIOSH] Information Collection Provisions in 42 CFR Part 84 - Tests and Requirements for Certification and Approval of Respiratory Protective Devices
OMB: 0920-0109
IC ID: 263388
OMB.report
HHS/CDC
OMB 0920-0109
ICR 202311-0920-004
IC 263388
( )
Documents and Forms
Document Name
Document Type
Form 0920-0109
Att 8_Test Participant Information Sheet
Form
0920-0109 Test Participant Information Sheet
Atch_8_InformationSheet.pdf
Form
0920-0109 Test Participant Information Sheet
Atch_8_InformationSheet.pdf
Form
Atch_8a_ConsentForm.pdf
Consent Form
IC Document
Atch_8a_ConsentForm.pdf
Consent Form
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Att 8_Test Participant Information Sheet
Agency IC Tracking Number:
0920-0109
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
0920-0109
Test Participant Information Sheet
Atch_8_InformationSheet.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
10
0
10
0
0
0
Annual IC Time Burden (Hours)
2
0
2
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Consent Form
Atch_8a_ConsentForm.pdf
11/14/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.