Barriers to Occupational Injury Reporting by Workers: A NEISS Telephone Interview Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Barriers to occupational injury reporting by workers	Form	New	Repair queued
111208_SupportStatement_SectionB_Barriers.docx	Supporting Statement B	Uploaded 2012-01-19	Available
AppF IRB approval.docx	Supplementary Document	Uploaded 2012-01-19	Available
AppE Topical experts.docx	Supplementary Document	Uploaded 2012-01-19	Available
AppC Barriers pre-interview letter 120502.docx	Supplementary Document	Uploaded 2012-05-09	Available
AppB 111006_FRN60day_Barriers.docx	Supplementary Document	Uploaded 2012-01-19	Available
AppA 29 USC 669.docx	Supplementary Document	Uploaded 2012-01-19	Available
ICR0920-11JY NIOSH Barriers SuppStat_A_NIOSH response 120526.docx	Supporting Statement A	Uploaded 2012-05-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
200876	Barriers to occupational injury reporting by workers	Form	New

ICR Details

OMB Control No: 0920-0939	ICR Reference No: 201201-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Barriers to Occupational Injury Reporting by Workers: A NEISS Telephone Interview Survey
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: 06/04/2012
	Date Received in OIRA: 01/23/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2014	24 Months From Approved
Responses	600	0	0
Time Burden (Hours)	300	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The NEISS occupational supplement (NEISS-Work) and injury supplement (NEISS-AIP) are collected by the Consumer Product Safety Commission and capture people who were treated in emergency departments for work-related and non-work-related injuries. This project will uses cases from these supplements to identify potential participants for a phone interview of employed persons to assess incentives and disincentives to reporting work-related injuries.

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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:
	76 FR 51981	08/19/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 2729	01/19/2012
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
Barriers to occupational injury reporting by workers	None	Appendix D Barriers to Reporting Questionnaire

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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	600	0	0	600	0	0
Annual Time Burden (Hours)	300	0	0	300	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 new ICR.

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Annual Cost to Federal Government: $84,850

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: 01/23/2012

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