Daily Pre-Shift Questionnaires

[NIOSH] Assessing Fatigue and Fatigue Management in U.S. Onshore Oil and Gas Extraction

Documents and Forms

Document Name Document Type
Form 0920-23HM Daily Pre-Shift Questionnaires Form
0920-23HM Daily Pre-Shift Questionnaires Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx Form
0920-23HM Daily Pre-Shift Questionnaires Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx Form
0920-23HM Daily Pre-Shift Questionnaires_Spanish Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx Form
0920-23HM Daily Pre-Shift Questionnaires_Spanish Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx Form

Information Collection (IC) Details

IC Title:	Daily Pre-Shift Questionnaires	Agency IC Tracking Number:	0920-23HM

Is this a Common Form? Yes		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	0920-23HM	Daily Pre-Shift Questionnaires	Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx		Yes	Yes	Fillable Fileable
Form	0920-23HM	Daily Pre-Shift Questionnaires_Spanish	Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,120	1,120
Annual IC Time Burden (Hours)	56	56
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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