OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Understanding Long-term Respiratory Morbidity in Former Styrene-exposed Workers: Medical Survey

ICR 202009-0920-016 · OMB 0920-1332 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Consent Form and Instruction New Repair queued
Former employee medical questionnaire Form New Repair queued
Attachment 22 PIA form.pdf Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 11 FDA package insert.pdf Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 9 Albuterol drug information.docx Supplementary Document Uploaded 2020-09-23 Available
Attachment 5 Medical survey Contol Card.pptx Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 21 IRB approval letter.pdf Supplementary Document Uploaded 2020-09-23 Missing upstream
Attachment 20 Notification Letter.docx Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 18 Information sheet_medical survey.ppt Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 17 General Invitation letter.docx Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 15 Information sheet.ppt Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 14 Information session ppt.pptx Supplementary Document Uploaded 2020-09-23 Available
Attachment 2 60 day FRN.pdf Supplementary Document Uploaded 2020-09-23 Repair queued
Attachment 1 Laws and Regulations.docx Supplementary Document Uploaded 2020-09-23 Missing upstream
SupSta B (9.15.20).docx Supporting Statement B Uploaded 2020-09-22 Repair queued
SupSta A_Updated (9.15.20).docx Supporting Statement A Uploaded 2020-09-22 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
243752 Consent Form and Instruction New
243750 Blood test procedures Instruction New
243749 Color vision test procedures Instruction New
243748 Bronchodilator test procedures Instruction New
243747 Spirometry procedures Instruction New
243746 Nitrogen multibreath washout test procedures Instruction New
243745 Impulse oscillometry procedures Instruction New
243744 Exhaled nitric oxide procedures Instruction New
243743 Former employee medical questionnaire Form New
ICR Details
202009-0920-016
Received in OIRA
HHS/CDC 0920-20IT
Understanding Long-term Respiratory Morbidity in Former Styrene-exposed Workers: Medical Survey
New collection (Request for a new OMB Control Number)   No
Regular 10/02/2020
  Requested Previously Approved
24 Months From Approved
2,729 0
712 0
16,391 0
The purpose of this project is to understand the prevalence of long-term respiratory morbidity in styrene-exposed workers. The sites of field research for this project are Bellingham, WA and Kelso, WA, which were the sites of two reinforced plastic boatbuilding plants that closed in 1989 and 1993. A maximum of 676 study subjects will be enrolled to participate in a medical and job history questionnaire, lung function testing, color vision assessment, and biomarker analysis.
US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  85 FR 11988 02/28/2020
85 FR 61950 10/01/2020
Yes
  Total Request 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 2,729 0 0 2,729 0 0
Annual Time Burden (Hours) 712 0 0 712 0 0
Annual Cost Burden (Dollars) 16,391 0 0 16,391 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$894,305
Yes Part B of Supporting Statement
    Yes
    Yes
No
No
No
No
Shari Steinberg 404 639-4942 [email protected]
  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.
10/02/2020