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Federal forms, ICRs, and supporting documents

Information Collection Request

CONTENTS OF A REQUEST FOR HEALTH HAZARD EVALUATION, REGULATION -- 42 CFR 85.3-1

ICR 199208-0920-003 · OMB 0920-0102 · Historical Active

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IC IDCollectionTypeStatusForm
110696 CONTENTS OF A REQUEST FOR HEALTH HAZARD EVALUATION, REGULATION -- 42 CFR 85.3-1 Form Migrated
ICR Details
0920-0102 199208-0920-003
Historical Active 198905-0920-004
HHS/CDC
CONTENTS OF A REQUEST FOR HEALTH HAZARD EVALUATION, REGULATION -- 42 CFR 85.3-1
Extension without change of a currently approved collection   No
Regular
Approved without change 11/09/1992
Retrieve Notice of Action (NOA) 08/11/1992
  Inventory as of this Action Requested Previously Approved
11/30/1995 11/30/1995 08/31/1992
500 0 500
100 0 100
0 0 0
THIS DATA COLLECTION IS AN APPLICATION FOR HEALTH HAZARD EVALUATION AS DESCRIBED IN 42 CFR 85.3-1. EMPLOYERS OR AUTHORIZED REPRESENTATIVE OF EMPLOYEES IN GENERAL INDUSTRY OR MINING MAY REQUEST AN EVALUATION TO DETERMINE WHETHER ANY SUBSTANCES NORMALLY FOUND IN THE PLACE OF EMPLOYMENT HAS POTENTIALLY TOXIC EFFECTS.
None
None
No
1
IC Title Form No. Form Name
CONTENTS OF A REQUEST FOR HEALTH HAZARD EVALUATION, REGULATION -- 42 CFR 85.3-1 CDC/NIOSH, 2.86
  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 500 500 0 0 0 0
Annual Time Burden (Hours) 100 100 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/11/1992