Information Collection

Noise and Hearing Questionnaire

IC 261723 under ICR 202502-0920-009 · OMB 0920-1416.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-22DI Noise and Hearing Questionnaire	Form and Instruction
Form 0920-22DI Attachment C_Noise_and_Hearing_Questionnaire Noise and Hearing Questionnaire	Form and Instruction
Form 0920-25-0022 Attachment C_Noise_and_Hearing_Questionnaire_amended Feb 2025 Noise and Hearing Questionnaire	Form
0920-22DI Attachment C_Noise_and_Hearing_Questionnaire Attachment C_Noise_and_Hearing_Questionnaire.docx	Form and Instruction
0920-22DI Attachment C_Noise_and_Hearing_Questionnaire Attachment C_Noise_and_Hearing_Questionnaire.docx	Form and Instruction
0920-25-0022 Attachment C_Noise_and_Hearing_Questionnaire_amended Feb Attachment C_Noise_and_Hearing_Questionnaire_amended Feb 2025.docx	Form
0920-25-0022 Attachment C_Noise_and_Hearing_Questionnaire_amended Feb Attachment C_Noise_and_Hearing_Questionnaire_amended Feb 2025.docx	Form

IC Title:

Agency IC Tracking Number:

0920-25-0022

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-22DI				Yes	Yes	Fillable Fileable
Form	0920-25-0022				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 167

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	167	167
Annual IC Time Burden (Hours)	47	47
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.

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