Request an HHE
If you have questions about this form, call us at (513) 841-4382 or send us an email at HHERequestHelp@cdc.gov.
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.
Public reporting burden of this collection of information is estimated to average 12 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS E-11, Atlanta, Georgia 30333; ATTN: PRA (0920-0260).
- National Institute for Occupational Safety and Health (NIOSH)
- Centers for Disease Control and Prevention
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