OMB control number

Pilot Study and Prospective Analysis of the Draft Revised Form 33, Safety and Health Program Assessment Worksheet

OMB 1218-0280 · DOL/OSHA.

OMB 1218-0280

OSHA conducts validity and reliability analyses of a safety and health program assessment worksheet, the Draft Revised Form 33. The studies will enable OSHA to ensure that a valid, reliable, and efficient tool is provided to On-Site Consultation programs in the fifty states, the District of Columbia, and several United States territories to replace the current OSHA Form 33, thereby, enhancing the quality of consultative services. The studies for which OSHA has requested approval comprises of a pre-test, a follow-up study, and a Prospective Analysis and OSHA is requesting additional time to complete the remaining studies. After completing the Pilot Study, OSHA will request OMB approval before implementing the DRF33 for use by state On-Site Consultation programs nationwide (to replace the current Form 33). Similarly, OSHA will seek OMB approval if any additional updates are made to the approved worksheet, following the Prospective Analysis.

The latest form for Pilot Study and Prospective Analysis of the Draft Revised Form 33, Safety and Health Program Assessment Worksheet expires 2028-06-30 and is listed under ICR 202501-1218-004.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form Form 33 On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)	Form and Instruction
Form Form 33 Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction
Pilot Study-form 33_1218-0280 Sup St A_4-9-25 ROCIS.docx	Supporting Statement A
OSHA Act Section 2- 29 USC 651.pdf	Supplementary Document
OSHA Act Section 2- 29 USC 651.pdf	Supplementary Document
OSH Act Section 21(d) - 29 USC 670.pdf	Supplementary Document
OSH Act Section 21(d) - 29 USC 670.pdf	Supplementary Document
eCFR 29 PART 1908.pdf	Supplementary Document
eCFR 29 PART 1908.pdf	Supplementary Document
1218-0NEW Pilot Study Procedures 100220 (3-22-2021 DCSP-OSBA).docx	Supplementary Document
1218-0NEW Pilot Study Procedures 100220 (3-22-2021 DCSP-OSBA).docx	Supplementary Document
60 day FR notice 1-13-25.pdf	Supplementary Document
60 day FR notice 1-13-25.pdf	Supplementary Document
Pilot Study Form 33_ 1218-0280 Sup St B _3-27-25 ROCIS.docx	Supporting Statement B
Summary of Estimated Respondent (Employer) Hour and Cost Burden	Information collection
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for the Prospective Analysis	Information collection
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202501-1218-004	Extension without change of a currently approved collection	2025-05-14
202202-1218-002	New collection (Request for a new OMB Control Number)	2022-05-19		Approved without change

OMB Details

Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study

Federal Enterprise Architecture: Workforce Management - Worker Safety

Information collection instruments
Form	Name	Electronic access	Type
Form Form 33	On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)	Printable Only	Form and instruction

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