[NIOSH] Occupational Exposures to Surgical Smoke in Veterinary Personnel

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-24AL Post-shift Questionnaire	Form	Unchanged	Available
Form 0920-24AL Post-shift Questionnaire	Form	Unchanged	Repair queued
Form 0920-25-0017 Att. 7Baseline Questionnaire_Nonsub change_Feb 2025 per EO	Form	Modified	Available
Form 0920-24AL Baseline Questionnaire	Form	Modified	Available
Form 0920-24AL Baseline Questionnaire	Form	Modified	Repair queued
Form 0920-24AL Informed Consent	Form	Unchanged	Available
Form 0920-24AL Informed Consent	Form	Unchanged	Repair queued
Form 0920-24AL Expression of Interest Form	Form	Unchanged	Available
Form 0920-24AL Expression of Interest Form	Form	Unchanged	Repair queued
OMB Control 0920-1449_Change Request form EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-26	Available
OMB Control 0920-1449_Change Request form EO 14168.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-26	Repair queued
Att. 10–IRB Approval Letter.pdf	Supplementary Document	Uploaded 2024-10-07	Available
Att. 10–IRB Approval Letter.pdf	Supplementary Document	Uploaded 2024-10-07	Repair queued
Att. 9–Letters of Support.docx	Supplementary Document	Uploaded 2024-10-07	Available
Att. 9–Letters of Support.docx	Supplementary Document	Uploaded 2024-10-07	Repair queued
Att. 4–Recruitment Email.docx	Supplementary Document	Uploaded 2024-10-07	Available
Att. 4–Recruitment Email.docx	Supplementary Document	Uploaded 2024-10-07	Available
Att. 3–Study Recruitment Fact Sheet.docx	Supplementary Document	Uploaded 2024-10-07	Available
Att. 3–Study Recruitment Fact Sheet.docx	Supplementary Document	Uploaded 2024-10-07	Repair queued
Att. 2–60-day FRN.pdf	Supplementary Document	Uploaded 2024-10-07	Available
Att. 2–60-day FRN.pdf	Supplementary Document	Uploaded 2024-10-07	Repair queued
Att. 1–Authorizing Legislation.docx	Supplementary Document	Uploaded 2024-10-07	Available
Att. 1–Authorizing Legislation.docx	Supplementary Document	Uploaded 2024-10-07	Repair queued
Veterinary Surgical Smoke_SSB.docx	Supporting Statement B	Uploaded 2024-10-07	Available
Veterinary Surgical Smoke_SSB.docx	Supporting Statement B	Uploaded 2024-10-07	Missing upstream
Veterinary Surgical Smoke_SSA_Revised20241025_Clean.docx	Supporting Statement A	Uploaded 2024-11-04	Available
Veterinary Surgical Smoke_SSA_Revised20241025_Clean.docx	Supporting Statement A	Uploaded 2024-11-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271430	Post-shift Questionnaire	Form	Unchanged	Post-shift Questionnaire
271430	Post-shift Questionnaire	Form	Unchanged
271429	Baseline Questionnaire	Form	Modified	Att. 7Baseline Questionnaire_Nonsub change_Feb 2025 per EO
271429	Baseline Questionnaire	Form	Modified	Baseline Questionnaire
271429	Baseline Questionnaire	Form	Modified
271428	Informed Consent	Form	Unchanged	Informed Consent
271428	Informed Consent	Form	Unchanged
271427	Expression of Interest Form	Form	Unchanged	Expression of Interest Form
271427	Expression of Interest Form	Form	Unchanged

ICR Details

OMB Control No: 0920-1449	ICR Reference No: 202502-0920-010
Status: Active	Previous ICR Reference No: 202410-0920-008
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0017
Title: [NIOSH] Occupational Exposures to Surgical Smoke in Veterinary Personnel
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/03/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/28/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	11/30/2027	11/30/2027
Responses	200	0	200
Time Burden (Hours)	107	0	107
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) seeks approval from the Office of Management and Budget (OMB) to conduct a study on surgical smoke (SS) and related respiratory health effects in U.S. clinical veterinary settings. The overarching goal of this project is to characterize occupational exposure to surgical smoke and related respiratory health effects in U.S. clinical veterinary settings. This study will describe surgical smoke-related respiratory health effects in VM/AC personnel and barriers/aids to implementing surgical smoke evacuation systems among VM/AC personnel.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 75595	11/03/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 79926	10/01/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Baseline Questionnaire	0920-24AL, 0920-25-0017	Baseline Questionnaire ,   Att. 7Baseline Questionnaire_Nonsub change_Feb 2025 per EO
Expression of Interest Form	0920-24AL	Expression of Interest Form
Informed Consent	0920-24AL	Informed Consent
Post-shift Questionnaire	0920-24AL	Post-shift Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	200	200	0	0	0	0
Annual Time Burden (Hours)	107	107	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $674,960

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/28/2025

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