[NIOSH] Increasing the Impact of NIOSH Heat Stress Products in Outdoor Worker Populations

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 261054

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

2025-07-16 - No material or nonsubstantive change to a currently approved collection
2025-07-09 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

Document Name Document Type
[NIOSH] Increasing the Impact of NIOSH Heat Stress Products in Outdoor Worker Populations Form and Instruction
[NIOSH] Increasing the Impact of NIOSH Heat Stress Products in Outdoor Worker Populations Form and Instruction
Attmt G-Recruitment_Consent_Form_English_Spanish 7-13-2023.docx Other-Consent
Attmt G-Recruitment_Consent_Form_English_Spanish 7-13-2023.docx Other-Consent
Focus Group Guide for Employers/Supervisors Attmt B- Focus Group Guide for Employers_Supervisors.docx Form and Instruction
Focus Group Guide for Employers/Supervisors Attmt B- Focus Group Guide for Employers_Supervisors.docx Form and Instruction
Focus Group Guide for Employees - English/Spanish Attmt C_ Focus Group Guide for Employees_English and Spanish 7-13-23.docx Form and Instruction
Focus Group Guide for Employees - English/Spanish Attmt C_ Focus Group Guide for Employees_English and Spanish 7-13-23.docx Form and Instruction
Training for Employers - Pre-test Attmt D- Training for Employers Pre Test Questions.docx Form and Instruction
Training for Employers - Pre-test Attmt D- Training for Employers Pre Test Questions.docx Form and Instruction
Training for Employers - Post-test Attmt E- Training for Employers Post test Questions.docx Form and Instruction
Training for Employers - Post-test Attmt E- Training for Employers Post test Questions.docx Form and Instruction
Attmt A- Authorizing Legislation.docx Authorizing Legislation IC Document
Attmt A- Authorizing Legislation.docx Authorizing Legislation IC Document
Attmt F- IRB determination.pdf Human Subjects Determination IC Document
Attmt F- IRB determination.pdf Human Subjects Determination IC Document
Supporting Statement A_final.docx SSA IC Document
Supporting Statement A_final.docx SSA IC Document
Supporting Statement B_Heat_Jacklitsch.docx SSB IC Document
Supporting Statement B_Heat_Jacklitsch.docx SSB IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	[NIOSH] Increasing the Impact of NIOSH Heat Stress Products in Outdoor Worker Populations	Agency IC Tracking Number:	0920-1154-23GV

IC Status: Unchanged

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
Form and Instruction	n/a	Focus Group Guide for Employers/Supervisors	Attmt B- Focus Group Guide for Employers_Supervisors.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Focus Group Guide for Employees - English/Spanish	Attmt C_ Focus Group Guide for Employees_English and Spanish 7-13-23.docx	Yes	No	Fillable Fileable
Form and Instruction	n/a	Training for Employers - Pre-test	Attmt D- Training for Employers Pre Test Questions.docx	Yes	Yes	Fillable Fileable
Form and Instruction	n/a	Training for Employers - Post-test	Attmt E- Training for Employers Post test Questions.docx	Yes	Yes	Fillable Fileable
Other-Consent			Attmt G-Recruitment_Consent_Form_English_Spanish 7-13-2023.docx	Yes	No	Fillable Fileable

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: 504	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 26 %

	Requested	Previously Approved
Annual Number of Responses for this IC	504	504
Annual IC Time Burden (Hours)	539	539
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Authorizing Legislation	Attmt A- Authorizing Legislation.docx	07/17/2023
Human Subjects Determination	Attmt F- IRB determination.pdf	07/17/2023
SSA	Supporting Statement A_final.docx	07/17/2023
SSB	Supporting Statement B_Heat_Jacklitsch.docx	07/17/2023

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