Information Collection Request

[NIOSH] Occupational Exposures to Surgical Smoke in Veterinary Personnel

ICR 202502-0920-010 · OMB 0920-1449 · Active

Forms and Documents

Document Name	Status
Form 0920-24AL Post-shift Questionnaire Form	Unchanged
Form 0920-24AL Post-shift Questionnaire Form	Unchanged
Form 0920-24AL Baseline Questionnaire Form	Modified
Form 0920-24AL Baseline Questionnaire Form	Modified
Form 0920-24AL Informed Consent Form	Unchanged
Form 0920-24AL Informed Consent Form	Unchanged
Form 0920-24AL Expression of Interest Form Form	Unchanged
Form 0920-24AL Expression of Interest Form Form	Unchanged
OMB Control 0920-1449_Change Request form EO 14168.docx Justification for No Material/Nonsubstantive Change	2025-02-26
OMB Control 0920-1449_Change Request form EO 14168.docx Justification for No Material/Nonsubstantive Change	2025-02-26
Att. 10–IRB Approval Letter.pdf Supplementary Document	2024-10-07
Att. 10–IRB Approval Letter.pdf Supplementary Document	2024-10-07
Att. 9–Letters of Support.docx Supplementary Document	2024-10-07
Att. 9–Letters of Support.docx Supplementary Document	2024-10-07
Att. 4–Recruitment Email.docx Supplementary Document	2024-10-07
Att. 4–Recruitment Email.docx Supplementary Document	2024-10-07
Att. 3–Study Recruitment Fact Sheet.docx Supplementary Document	2024-10-07
Att. 3–Study Recruitment Fact Sheet.docx Supplementary Document	2024-10-07
Att. 2–60-day FRN.pdf Supplementary Document	2024-10-07
Att. 2–60-day FRN.pdf Supplementary Document	2024-10-07
Att. 1–Authorizing Legislation.docx Supplementary Document	2024-10-07
Att. 1–Authorizing Legislation.docx Supplementary Document	2024-10-07
Veterinary Surgical Smoke_SSB.docx Supporting Statement B	2024-10-07
Veterinary Surgical Smoke_SSB.docx Supporting Statement B	2024-10-07
Veterinary Surgical Smoke_SSA_Revised20241025_Clean.docx Supporting Statement A	2024-11-04
Veterinary Surgical Smoke_SSA_Revised20241025_Clean.docx Supporting Statement A	2024-11-04

IC Document Collections

IC ID	Document Title	Status
271430	Post-shift Questionnaire Form	Unchanged
271430	Post-shift Questionnaire Form	Unchanged
271429	Baseline Questionnaire Form	Modified
271429	Baseline Questionnaire Form	Modified
271428	Informed Consent Form	Unchanged
271428	Informed Consent Form	Unchanged
271427	Expression of Interest Form Form	Unchanged
271427	Expression of Interest Form Form	Unchanged

ICR Details

Status	Active
Agency/Subagency	HHS/CDC
OMB Control No	0920-1449
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202410-0920-008
Agency Tracking No	0920-25-0017
Date Submitted to OIRA	2025-03-28
Requested Expiration Date	1969-12-31