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Appx M_ Consent Form Environment Chamber (M/FF/CW)
[NIOSH] Heat-related Changes in Cognitive Performance
OMB: 0920-1331
IC ID: 243410
OMB.report
HHS/CDC
OMB 0920-1331
ICR 202310-0920-010
IC 243410
( )
Documents and Forms
Document Name
Document Type
Form 0920-1331
Appx M_ Consent Form Environment Chamber (M/FF/CW)
Form and Instruction
0920-1331 Consent to be in a Research Study Health-related changes
Appendix M Consent form environmental chamber.docx
Form and Instruction
0920-1331 Consent to be in a Research Study Health-related changes
Appendix M Consent form environmental chamber.docx
Form and Instruction
Appendix J Recruitment Script - chamber.docx
Appx J_ Recruitment Script - Chamber
IC Document
Appendix J Recruitment Script - chamber.docx
Appx J_ Recruitment Script - Chamber
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Appx M_ Consent Form Environment Chamber (M/FF/CW)
Agency IC Tracking Number:
0920-1331
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1331
Consent to be in a Research Study Health-related changes in cognitive performance
Appendix M Consent form environmental chamber.docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
15
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15
0
0
0
0
15
Annual IC Time Burden (Hours)
8
0
0
0
0
8
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appx J_ Recruitment Script - Chamber
Appendix J Recruitment Script - chamber.docx
10/30/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.