Employee - HHE Specific Medical Survey Informed Consent

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

OMB: 0920-0260

IC ID: 185720

Information Collection (IC) Details

View Information Collection (IC)

Employee - HHE Specific Medical Survey Informed Consent 0920-0260
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0260 HHE Specific Medical Survey Informed Consent Form Attachment E Medical Survey Informed Consent Example.docx N/A Yes Yes Fillable Fileable

Workforce Management Worker Safety

Occupational Health Epidemiological Studies  76 FR 34706

150 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   50 %

  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 150 0 10 0 0 140
Annual IC Time Burden (Hours) 75 0 52 0 0 23
Annual IC Cost Burden (Dollars) 0 0 -797 0 0 797

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