Employees - HHE specific interview example

[NIOSH] Health Hazard Evaluations/Technical Assistance and Emerging Problems

Documents and Forms

Document Name Document Type
Form 0920-0260 Employees - HHE specific interview example Form and Instruction
0920-0260 HHE - Specific Interview Example Attachment C Interview Example.docx Form and Instruction
0920-0260 HHE - Specific Interview Example Attachment C Interview Example.docx Form and Instruction
Att C1_Hlth Haz Eval Req Form - Spanish.docx Att C1_HHE Request Form (Spanish version) IC Document
Att C1_Hlth Haz Eval Req Form - Spanish.docx Att C1_HHE Request Form (Spanish version) IC Document

Information Collection (IC) Details

IC Title:	Employees - HHE specific interview example	Agency IC Tracking Number:	0920-0260

Is this a Common Form? No		IC Status: Modified

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	0920-0260	HHE - Specific Interview Example	Attachment C Interview Example.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: Occupational Health Epidemiological Studies	FR Citation: 76 FR 34706

Number of Respondents: 1,710	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,710	1,460	250
Annual IC Time Burden (Hours)	428	378	50
Annual IC Cost Burden (Dollars)	0	-1,708	1,708

Documents for IC

Title	Document	Date Uploaded
Att C1_HHE Request Form (Spanish version)	Att C1_Hlth Haz Eval Req Form - Spanish.docx	06/02/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.