OMB control number

[NIOSH] Heat-related Changes in Cognitive Performance

OMB 0920-1331 · HHS/CDC.

OMB 0920-1331

The purpose of this study is to collect information on burden of heat strain among miners as well as factors related to personal risk and core body temperature that contribute to individual variability in heat tolerance and to declines in heat-related worker performance. The goal of the study is to assess the following: (1) whether a core body temperature threshold exists at which cognitive performance beings to decline, (2) factors that contribute to inter- and intra- individual variability in cognitive physiologic responses to heat, and (2) patterns of heat strain among miners in both surface and underground mines. The intended use for this data is to develop guidance and strategies to mitigate risk of heat strain among miners. This guidance will build on the strategies currently used by mining but will include information on how to incorporate personal factors and physiologic measurements into current heat strain monitoring and prevention practices.

The latest form for [NIOSH] Heat-related Changes in Cognitive Performance expires 2027-04-30 and is listed under ICR 202310-0920-010.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1331 Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	Form
Form 0920-1331 Appx N_ Release of Information (HIPPA) (M/FF/CW)	Form
Form 0920-1331 Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction
Form 0920-1331 Appx L Consent (Field component) _Miners	Form and Instruction
Form 0920-1331 Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Form
Form 0920-1331 Appx F_Physcal Examination (M/FF/CW)	Form
Form 0920-1331 Appx C_Initial Participant Questionnaire: Field (Health screening)	Form and Instruction
Appendix Q IRB amendment approval.pdf	Supplementary Document
PIA.pdf	Supplementary Document
Appendix B 60 day FRN.pdf	Supplementary Document
Appendix A Federal Mine Safety and Health Act.docx	Supplementary Document
SMRD_Heat stress_SSB.docx	Supporting Statement B
SSA_SMRD_Heat Stress_02-27-24.docx	Supporting Statement A
Cognitive test: N-back -- no form (M/FF/CW)	Instruction
Consent - Research Study (PVT Cognitive Test) - Field (M/FF/CW)	Instruction
Appx O_ Exertion and Thermal Sensation Scale (M/FF/CW)	Form
Appx N_ Release of Information (HIPPA) (M/FF/CW)	Form
Fingerstick blood sample for point of care testing	Instruction
Fitting of Chest Strap (M/FF/CW)	Instruction
Ingestion of Temperature Pill (M/FF/CW)	Instruction
Appx K_Field Recruitment Script (PVT Cognitive Test) _Miner	Instruction
Fitting of Chest Strap (M)	Instruction
Consent Form - (Ingestion of Temperature Pill (M))	Instruction
Appx M_ Consent Form Environment Chamber (M/FF/CW)	Form and Instruction
Appx L Consent (Field component) _Miners	Form and Instruction
Appx I_ Pre-Test Questionnaire (M/FF/CW)	Other-App (WORD)
Appx H_PANAS sleepiness fatigue (M/FF/CW)	Other-WORD
Appx G_Health Screen Questionnaire -- Environment Chamber (M/FF/CW)	Form
Appx F_Physcal Examination (M/FF/CW)	Form
Appx E -Pre-Shift Questionnaire on Heat Stress (App) Miners	Other-App (WORD)
Appx D - Questionnaire on Heat Stress (App) Miners-- Shift for field	Other-App (WORD)
Appx C_Initial Participant Questionnaire: Field (Health screening)	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202310-0920-010	Revision of a currently approved collection	2024-02-28		Approved with change
202008-0920-005	New collection (Request for a new OMB Control Number)	2020-09-02		Approved without change

OMB Details

Appx C_Initial Participant Questionnaire: Field (Health screening)

Federal Enterprise Architecture: Workforce Management - Worker Safety

Information collection instruments
Form	Name	Electronic access	Type
Form 0920-1331	Initial Participant Questionnaire: Field	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.