Safety and Health Information Collection

ICR 202408-0693-002

OMB: 0693-0080

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Form
Modified
Form
Modified
Supplementary Document
2024-08-27
Supporting Statement A
2024-08-28
Supplementary Document
2021-07-26
IC Document Collections
IC ID
Document
Title
Status
231570 Modified
231569 Modified
231567 Modified
ICR Details
0693-0080 202408-0693-002
Received in OIRA 202207-0693-001
DOC/NIST MO
Safety and Health Information Collection
Extension without change of a currently approved collection   No
Regular 08/28/2024
  Requested Previously Approved
36 Months From Approved 09/30/2024
999 999
168 168
0 0

The National Institute of Standards and Technology (NIST) is a unique federal campus which hosts daily a range of non-federal individuals. Non-federal individuals may include NIST Associates, volunteers, students, and visitors. In order to provide these individuals with proper care and health documentation, NIST is pursuing renewal of approval of three health unit forms to be utilized for these individuals.

None
None

Not associated with rulemaking

  89 FR 42847 05/16/2024
89 FR 68862 08/28/2024
No

3
IC Title Form No. Form Name
Audiological History NIST-426 Audiological History
Health Record NIST-986 Health Record
Injury / Illness / Exposure Assessment NIST-985 Injury / Illness / Exposure Assessment

  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 999 999 0 0 0 0
Annual Time Burden (Hours) 168 168 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$87,000
No
    Yes
    Yes
No
No
No
No
Stephen Banovic 301 975-8822

  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.
08/28/2024


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