OMB control number

[NIOSH] Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry

OMB 0920-1416 · HHS/CDC.

OMB 0920-1416

The proposed data collection will provide an initial step toward achieving a prioritized activity goals identified by the National Occupational Research Agenda (NORA) for workers in the Oil and Gas sector, specifically addressing goals related to hearing loss. NORA is a partnership program designed to stimulate innovative research and improve workplace practices. Unveiled in 1996, NORA has become a research framework for NIOSH and the nation. Diverse parties (industry, academia, government, insurance, etc.) collaborate to identify the most critical issues in workplace safety and health.

The latest form for [NIOSH] Noise Exposures and Hearing Loss in the Oil and Gas Extraction Industry expires 2026-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-22DI Audiometry Testing Form and Instruction
Form 0920-22DI Audiometry Testing Form and Instruction
Form 0920-22DI Informed Consent Form and Instruction
Form 0920-22DI Informed Consent Form and Instruction
Form 0920-22DI Noise and Hearing Questionnaire Form and Instruction
Form 0920-22DI Noise and Hearing Questionnaire Form and Instruction
Change Request form EO 14168_BK.docx Justification for No Material/Nonsubstantive Change
Change Request form EO 14168_BK.docx Justification for No Material/Nonsubstantive Change
Attachment B_60_day FRN.pdf Supplementary Document
Attachment B_60_day FRN.pdf Supplementary Document
NIOSH IRB Conditional Approval Report.docx Supplementary Document
NIOSH IRB Conditional Approval Report.docx Supplementary Document
Attachment J_Audiometric exam results notification letter.docx Supplementary Document
Attachment J_Audiometric exam results notification letter.docx Supplementary Document
Attachment I_Exposure results notification letter.docx Supplementary Document
Attachment I_Exposure results notification letter.docx Supplementary Document
Attachment H_Sample forms.docx Supplementary Document
Attachment H_Sample forms.docx Supplementary Document
Attachment E_Fact sheet.docx Supplementary Document
Attachment E_Fact sheet.docx Supplementary Document
Attachment D_Introductory recruitment letter.docx Supplementary Document
Attachment D_Introductory recruitment letter.docx Supplementary Document
Attachment A - Authorizing Legislation.docx Supplementary Document
Attachment A - Authorizing Legislation.docx Supplementary Document
Supporting Statement B_04-12-23.docx Supporting Statement B
Supporting Statement B_04-12-23.docx Supporting Statement B
Supporting Statement A_04-12-23.docx Supporting Statement A
Supporting Statement A_04-12-23.docx Supporting Statement A
Audiometry Testing Form and Instruction
Audiometry Testing Form and Instruction
Informed Consent Form and Instruction
Informed Consent Form and Instruction
Noise and Hearing Questionnaire Form and Instruction
Noise and Hearing Questionnaire Form and Instruction

All Historical Document Collections

202502-0920-009	No material or nonsubstantive change to a currently approved collection	2025-03-28
202308-0920-005 Approved without change	New collection (Request for a new OMB Control Number)	2023-08-30

OMB Details

Noise and Hearing Questionnaire

Federal Enterprise Architecture: Workforce Management - Worker Safety

Form 0920-25-0022	Attachment C_Noise_and_Hearing_Questionnaire_amended Feb 2025	Fillable Fileable	Form
Form 0920-22DI	Attachment C_Noise_and_Hearing_Questionnaire	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.