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Federal forms, ICRs, and supporting documents

Information Collection Request

Work and Health Study: Risk Factors for Heart Disease and Depression in the Workplace

ICR 200308-0920-001 · OMB 0920-0602 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7067 Work and Health Study: Risk Factors for Heart Disease and Depression in the Workplace Migrated
ICR Details
0920-0602 200308-0920-001
Historical Active
HHS/CDC
Work and Health Study: Risk Factors for Heart Disease and Depression in the Workplace
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 10/22/2003
Retrieve Notice of Action (NOA) 08/05/2003
  Inventory as of this Action Requested Previously Approved
10/31/2006 10/31/2006
90,048 0 0
28,860 0 0
0 0 0
NIOSH plans to conduct a prospective cohort sutdy of 20000 workers to identify the effect of specific job stressors on the occurrence of heart disease and depression. The study will involve one in-person baseline evaluation, followed by three annual mailed questionnaires, as well as evaluations of the work sties. Known risk factors for heart disease and depression, as well as other sources of stress outside the workplace will be evaluated.
None
None
No
1
IC Title Form No. Form Name
Work and Health Study: Risk Factors for Heart Disease and Depression in the Workplace
  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 90,048 0 0 90,048 0 0
Annual Time Burden (Hours) 28,860 0 0 28,860 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
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.
08/05/2003