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Health Hazard Evaluations | |
You can also send the completed form to: National Institute for Occupational Safety and
Health Or fax this request form to: (513)841-4488 Statement of authority: Sections 20(a)(3-6) of the Occupational Safety and Health Act (29 USC 669(a)(6-9), and Section 501(a)(11) of the Federal Mine Safety and Health Act (30 USC 951(a)(11)). Confidentiality of the respondent requester will be maintained in accordance with the provisions of the Privacy Act (5 USC 552a). The voluntary cooperation of the respondent requester is required to initiate the Health Hazard Evaluation. This form is provided to assist in requesting a health hazard evaluation from the U.S. Department of Health and Human Services. Public reporting burden for this collection of information is estimated to average 12 minutes per response. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to PHS Reports Clearance Officer, ATTN: PRA, Hubert H. Humphrey Bldg., Rm. 721-B, 200 Independence Ave., SW, Washington, D.C., 20503. << Back to HHE Program Home Page |
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