Appendix (EtO)
Appendix D (EtO).docx
Ethylene Oxide Standard (29 CFR 1910.1047)
Appendix (EtO)
OMB: 1218-0108
Ethylene Oxide Standard Appendix D PRA Public Burden Statement
§ 1910.1047 Ethylene Oxide.
Appendix D to § 1910.1047—Nonmandatory Medical Disease Questionnaire
PAPERWORK REDUCTION ACT
STATEMENT Under
the formaldehyde standard, this nonmandatory medical disease
questionnaire may be administered to employees who are included in
their employer’s medical surveillance program. (29 CFR
1910.1048(l)(1)). Under the Paperwork Reduction Act, a Federal
agency generally cannot conduct or sponsor, and the public is
generally not required to respond to, an information collection,
unless it is approved by OMB and displays a valid OMB Control
Number. Use of this questionnaire is optional. The questionnaire
assists both physicians and employers to ensure that the physician
obtains compliant employee medical documentation. OSHA estimates
employer burden for the completion of this collection of information
is 60 minutes (1 hour). This estimate includes the time for
reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and, completing and reviewing the
collection of information. The time estimate includes employer time
for compliance with the underlying information collection
requirements in 29 CFR 1910.1048(l), including employee time for
completion of the questionnaire and medical examination and
providing information to the physician. Send comments regarding
this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden to
OSHAPRA@dol.gov or to OSHA’s
Directorate of Standards and Guidance, Department of Labor, Room
N-3718, 200 Constitution Ave., NW, Washington, DC 20210; Attn:
Paperwork Reduction Act Comment; 1218-0145. (This address is for
comments regarding this form only; DO
NOT SEND ANY COMPLETED SAMPLE FORM TO THIS OFFICE.)
OMB
Approval# 1218-0145; Expires: 00-00-0000
§1910.1048—Nonmandatory Medical Disease Questionnaire
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Washington, Robert - OSHA |
| File Modified | 0000-00-00 |
| File Created | 2023-12-15 |
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