Survey to Evaluate Occupational and Safety Educational Materials for Home Care Workers

Forms and Documents

Document Name	Status
Att I- Consent Documents (3).docx Supplementary Document	2011-03-08
Att L NIOSH Health Hazard Evaluation Report.docx Supplementary Document	2011-02-25
SS PART B.doc Supporting Statement B	2010-10-29
Att I_Consent documents.doc Supplementary Document	2010-10-29
Att K_Sources of Survey Questions.doc Supplementary Document	2010-10-29
Att H_Confidentiality Stmt.doc Supplementary Document	2010-10-29
Att G_ HSRB.doc Supplementary Document	2010-10-29
Att J_Rcruitment Flyer and Reminder Notes.doc Supplementary Document	2010-10-29
Att B1- Stakeholder Participants.doc Supplementary Document	2010-10-29
Att B_60 FRN.doc Supplementary Document	2010-10-29
Att A_ Authorizing Leg.doc Supplementary Document	2010-10-29
Att E_Stakeholder Letters of Support.doc Supplementary Document	2010-11-01
Att F1_HC Handbook.pdf Supplementary Document	2010-11-01
Att D1_Recruitment Info.doc Supplementary Document	2010-11-01
Att I_Consent documents.doc Supplementary Document	2010-11-01
Att I_Consent documents.doc Supplementary Document	2010-11-01
Att I_Consent documents.doc Supplementary Document	2010-11-01
Att I_Consent documents.doc Supplementary Document	2010-10-29
SS PART A_102910 OMBcomments.docx Supporting Statement A	2011-02-25

IC Document Collections

IC ID	Document Title	Status
195736	Home Care Worker Training Curriculum Guide Other-WORD	New
195735	Home Care Worker Interest Response Form Other-WORD	New
195734	Client Post Survey (English, Spanish and Chinese) Other-WORD	New
195733	Client Pre Survey (English, Spanish, and Chinese) Other-WORD	New
195732	Home Care Worker Post Survey (English, Spanish, and Chinese) Other-WORD	New
195731	Home Care Worker Pre Survey (English, Spanish, and Chinese) Other-WORD	New

ICR Details

OMB Control No: 0920-0880	ICR Reference No: 201012-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Survey to Evaluate Occupational and Safety Educational Materials for Home Care Workers
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: 03/18/2011
	Date Received in OIRA: 12/16/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	12 Months From Approved
Responses	2,100	0	0
Time Burden (Hours)	842	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The mission of the National Institute for Occupational Safety and Health (NIOSH) is to promote safety and health at work for all people through research and prevention. Under Public Law 91-596, Sections 20 and 22 (section 20-22, Occupational Safety and Health Act of 1970); NIOSH has the responsibility to conduct research to advance the health and safety of workers. In this capacity, NIOSH will conduct a survey of home care workers to evaluate newly developed educational intervention materials. NIOSH has developed educational intervention materials for home care workers to prevent exposure to work-related hazards. The intervention materials consist of a printed handbook and a training session that explains how to use the handbook. The primary goal of the handbook and training session is to help home care workers and their clients identify hazards, discuss these hazards and identify accessible and low cost tips and tools for minimizing exposures to hazards. These materials have been developed and piloted in Alameda County, California. The goal of this data collection is to evaluate these materials before disseminating them more broadly. The study population for this survey includes current home care workers and their clients who are enrolled in the In-Home Supportive Services (IHSS) Program in Alameda County, California. The purpose of this information collection is to evaluate whether or not the educational materials (the Home Care Worker Handbook and training session) are effective in (1) conveying the intended message and (2) encouraging home care workers and their clients to make changes to reduce hazards.

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Authorizing Statute(s): PL: Pub.L. 29 - 671 20 Name of Law: Occupational Safety and Health Act
  

Citations for New Statutory Requirements: PL: Pub.L. 29 - 671 20 Name of Law: Occupational Safety and Health Act

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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:
	75 FR 12754	03/17/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 67374	11/02/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Home Care Worker Post Survey (English, Spanish, and Chinese)
Home Care Worker Pre Survey (English, Spanish, and Chinese)
Client Pre Survey (English, Spanish, and Chinese)
Client Post Survey (English, Spanish and Chinese)
Home Care Worker Interest Response Form
Home Care Worker Training Curriculum Guide

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ICR Summary 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	2,100	0	2,100	0	0	0
Annual Time Burden (Hours)	842	0	842	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement: This is a new collection request for a new OMB Control Number.

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Annual Cost to Federal Government: $108,350

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 12/16/2010

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