Survey of Healthcare Workers' Health and Safety Practices

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10 Healthcare Workers Core Module	Form and Instruction	New	Available
Form 4 Secondary Hazard Module	Form and Instruction	New	Available
Form 6 Healthcare Workers Primary Hazard Module	Form and Instruction	New	Available
Form 2 Healthcare Workers Screening Module	Form and Instruction	New	Available
Attachment H2_SamplingSmallOrgs_072310.docx	Supplementary Document	Uploaded 2010-08-05	Available
Attachment H1_SamplingLargeOrgs_FINAL_08042010.docx	Supplementary Document	Uploaded 2010-08-05	Available
Supporting Statement B_0 8_02_2010 (2).docx	Supporting Statement B	Uploaded 2010-08-03	Available
Attachment G_Web Page Materials_72310.docx	Supplementary Document	Uploaded 2010-08-05	Available
ICR Attmt F_HSRB Memo_3.1.10.docx	Supplementary Document	Uploaded 2010-04-01	Available
ICR Attmt E_Public MeetingFRN_3.1.10.docx	Supplementary Document	Uploaded 2010-04-01	Available
ICR Attmt D 60-day FRN.pdf	Supplementary Document	Uploaded 2010-04-01	Available
ICR Attmt C_LtrsofSupport_3.1.10.docx	Supplementary Document	Uploaded 2010-04-01	Available
ICR Attmt B_NIOSHSurvGoal3_3.1.10.docx	Supplementary Document	Uploaded 2010-04-01	Available
ICR Attmt A_OSHAct_3.1.10.docx	Supplementary Document	Uploaded 2010-04-01	Available
Supporting Statement A_08_02_2010.docx	Supporting Statement A	Uploaded 2010-08-04	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192663	Healthcare Workers Core Module	Form and Instruction	New
192662	Secondary Hazard Module	Form and Instruction	New
192661	Healthcare Workers Primary Hazard Module	Form and Instruction	New
192660	Healthcare Workers Screening Module	Form and Instruction	New
192659	Professional Organizations	Instruction	New

ICR Details

OMB Control No: 0920-0860	ICR Reference No: 201004-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Survey of Healthcare Workers' Health and Safety Practices
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 with change	Conclusion Date: 08/11/2010
	Date Received in OIRA: 04/21/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2012	24 Months From Approved
Responses	68,764	0	0
Time Burden (Hours)	11,140	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Survey of Healthcare Workers' Health and Safety Practices is a web-based hazard surveillance survey designed to provide important information on work practices associated with the use of important classes of hazardous chemical agents including antineoplastic agents, anesthetic gases, aerosolized medications, chemical sterilants, high level disinfectants and surgical smoke. The data collected will describe the prevalence and distribution of health and safety practices and the use of exposure controls and barriers to their use by chemical agent, by occupation, and by type and by size of work setting. The study population includes professional organizations who have agreed to participate in the survey by making the on-line survey available to their members via e-mail utilizing a sampling approach developed by NIOSH. The organizational members represent healthcare workers in many occupations that use or come in contact with the targeted hazardous chemical agents. The proposed survey is modular in design and will be only available on-line. The survey includes a screening module, separate chemical hazard modules addressing each of the hazardous chemical agents, and a core module which gathers information on a broad range of health and safety issues affecting healthcare workers in addition to demographic information. The web survey will present the modules to respondents in a seamless manner. Respondents will not be asked to report their names or any other identifying information.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act
  

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:
	74 FR 64088	12/07/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 16485	04/01/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Healthcare Workers Screening Module	2	Healthcare Workers Screening Module
Professional Organizations
Healthcare Workers Primary Hazard Module	3, 5, 4, 6, 7, 8, 9	Chemical Sterilants ,   Healthcare Workers Primary Hazard Module ,   Antineoplastic Agents (Compound) ,   Anesthetic Gases ,   Surgical Smoke ,   High Level Disinfectants ,   Antineoplastic Agents (Administer)
Secondary Hazard Module	3, 5, 4, 6, 7, 8, 9	Antineoplastic Agents (Compound) ,   Chemical Sterilants ,   Surgical Smoke ,   Anesthetic Gases ,   Healthcare Workers Primary Hazard Module ,   Antineoplastic Agents (Administer) ,   High Level Disinfectants
Healthcare Workers Core Module	10	Healthcare Workers Core Module

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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	68,764	0	0	68,764	0	0
Annual Time Burden (Hours)	11,140	0	0	11,140	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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 request for a new ICR.

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Annual Cost to Federal Government: $368,750

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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)? No

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: 04/21/2010

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