Low Back Exposure Assessment Tool for Mining

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Low Back Exposure Assessment Tool for Mining	Form and Instruction	New	Available
Supporting Statement B	Supporting Statement B	Uploaded 2007-03-13	Available
30 day FINAL.pdf	Supplementary Document	Uploaded 2007-03-13	Available
Appendix A.Public Law.doc	Supplementary Document	Uploaded 2007-03-09	Available
Public Comments Email 11.18.05.pdf	Supplementary Document	Uploaded 2007-03-09	Available
List of Appendices.doc	Supplementary Document	Uploaded 2007-03-09	Available
Supporting Statement fINAL 3.06.07.doc	Supporting Statement A	Uploaded 2007-06-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181183	Low Back Exposure Assessment Tool for Mining	Form and Instruction	New

ICR Details

OMB Control No: 0920-0758	ICR Reference No: 200707-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Low Back Exposure Assessment Tool for Mining
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/02/2007
	Date Received in OIRA: 07/13/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2008	12 Months From Approved
Responses	320	0	0
Time Burden (Hours)	80	0	0
Cost Burden (Dollars)	8,320	0	0

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Abstract: Mining has one of the highest incidence rates for back pain of any industry and back injuries are consistently the leading cause of lost work days in the industry. The objective of this project is to develop a self-administered, paper and pencil risk assessment tool for the development of low back disorders specifically directed towards use in the mining industry. This tool will assess various occupational exposures associated with development of back disorders in the literature as well as specific mining stressors and will develop a score that will be used to assess the degree of risk for the job and the individual. The tool will be useful in both prioritizing jobs that need interventions to reduce low back disorder risk and in evaluating the effectiveness of interventions through tool administration before and after the implementation of an intervention.

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Authorizing Statute(s): PL: Pub.L. 91 - 256 501 Name of Law: Federal Mine Safety and Health Act
   PL: Pub.L. 91 - 256 501 Name of Law: Federal Mine Safety and Health Act of 1970
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 15885	04/03/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 11026	03/03/2007
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Low Back Exposure Assessment Tool for Mining	None	Appendix C: Low Back Assessment

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	320	0	0	320	0	0
Annual Time Burden (Hours)	80	0	0	80	0	0
Annual Cost Burden (Dollars)	8,320	0	0	8,320	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new data collection. This tool will assess various occupational exposures associated with development of back disorders. There were no public comments received for the the newly published 60-day dated 04/03/2007.

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Annual Cost to Federal Government: $155,908

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/13/2007

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