Occupational Data for Health (ODH) Prototype usability testing

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
footer.png Other-Footer
header.png Other-header
0920-0953 PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA F Attachment A- Pretest.docx Form
0920-0953 POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) Attachment B- Post-test.docx Form
0920-0953 Occupational Data for Health (OHD) Phototype Version 3 Summary screen.JPG Form and Instruction
0920-0953 Employment Status & Retirement dates Employment Status & retirement dates.JPG Form
0920-0953 Longest Held Occupation Longest Held Occupation.JPG Form
0920-0953 Work History Work History.JPG Form
NIOSH GenIC- ODH Prototype usability testing.docx Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Occupational Data for Health (ODH) Prototype usability testing	Agency IC Tracking Number:	0920-0953-19BNK

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-header			header.png	Yes	No	Printable Only
Form and Instruction	0920-0953	Occupational Data for Health (OHD) Phototype Version 3	Summary screen.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Employment Status & Retirement dates	Employment Status & retirement dates.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Longest Held Occupation	Longest Held Occupation.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	Work History	Work History.JPG	Yes	Yes	Fillable Fileable
Form	0920-0953	PRE-TEST DEMOGRAPHIC DATA SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH) PROTOTYPE USABILITY TESTING	Attachment A- Pretest.docx	Yes	Yes	Fillable Fileable
Form	0920-0953	POST-TEST SURVEY FOR OCCUPATIONAL DATA FOR HEALTH (ODH)	Attachment B- Post-test.docx	Yes	Yes	Fillable Fileable
Other-Footer			footer.png	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	NIOSH GenIC- ODH Prototype usability testing.docx	09/30/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.