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Daily Pre-Shift Questionnaires
[NIOSH] Assessing Fatigue and Fatigue Management in U.S. Onshore Oil and Gas Extraction
OMB: 0920-1436
IC ID: 266348
OMB.report
HHS/CDC
OMB 0920-1436
ICR 202403-0920-015
IC 266348
( )
Documents and Forms
Document Name
Document Type
Form 0920-23HM
Daily Pre-Shift Questionnaires
Form
0920-23HM Daily Pre-Shift Questionnaires
Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx
Form
0920-23HM Daily Pre-Shift Questionnaires
Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx
Form
0920-23HM Daily Pre-Shift Questionnaires_Spanish
Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx
Form
0920-23HM Daily Pre-Shift Questionnaires_Spanish
Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Daily Pre-Shift Questionnaires
Agency IC Tracking Number:
0920-23HM
Is this a Common Form?
Yes
IC Status:
New
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
0920-23HM
Daily Pre-Shift Questionnaires
Attachment 3c - Questionnaire_PreShift_Fatigue OGE.docx
Yes
Yes
Fillable Fileable
Form
0920-23HM
Daily Pre-Shift Questionnaires_Spanish
Attachment 3d - Questionnaire_PreShift_Fatigue OGE- ES.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
80
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
1,120
0
1,120
0
0
0
Annual IC Time Burden (Hours)
56
0
56
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.