Information Collection

[NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot

IC 275347 under ICR 202507-0920-001 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-25-0059 [NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot	Form
Form 0920-25-0059 MVC_Priorities_Interview [NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot	Form
Form 0920-25-0059 IVMS_Interview [NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot	Form
Form 0920-25-0059 Data_Interview [NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot	Form
0920-25-0059 MVC_Priorities_Interview Att3_MVC_Priorities_Interview.docx	Form
0920-25-0059 MVC_Priorities_Interview Att3_MVC_Priorities_Interview.docx	Form
0920-25-0059 IVMS_Interview Att4_IVMS_Interview.docx	Form
0920-25-0059 IVMS_Interview Att4_IVMS_Interview.docx	Form
0920-25-0059 Data_Interview Att6_Data_Interview.docx	Form
0920-25-0059 Data_Interview Att6_Data_Interview.docx	Form
Att1_42_USC_6A.pdf Authorizing Legislation	IC Document
Att1_42_USC_6A.pdf Authorizing Legislation	IC Document
Att2_29_USC_669.pdf Authorizing Legislation	IC Document
Att2_29_USC_669.pdf Authorizing Legislation	IC Document
Att5_IVMS_Draft_Questionnaire.docx Draft Questionnaire	IC Document
Att5_IVMS_Draft_Questionnaire.docx Draft Questionnaire	IC Document
SSA.2022_ScottK_RegionalMonitoring_02242025_CLEAN.docx SSA	IC Document
SSA.2022_ScottK_RegionalMonitoring_02242025_CLEAN.docx SSA	IC Document

IC Title:

[NIOSH] Formative Needs Assessment for Regional Worker Health Monitoring in a Rural Oil and Gas Basin: A Pilot

Agency IC Tracking Number:

0920-25-0059

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0920-25-0059	Yes	Yes	Fillable Fileable
Form	0920-25-0059	Yes	Yes	Fillable Fileable
Form	0920-25-0059	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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

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