Validation of an Occupational Safety and Health Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment J.docx	Supplementary Document	Uploaded 2012-06-01	Available
Sup Sta B.doc	Supporting Statement B	Uploaded 2012-01-30	Available
Att.C_IRB.docx	Supplementary Document	Uploaded 2012-01-30	Repair queued
Att. A_Authorizing Leg.docx	Supplementary Document	Uploaded 2012-01-30	Available
Att. B_60 day FRN.pdf	Supplementary Document	Uploaded 2012-01-30	Available
Supt Sta_11EP_Validation of OSHQ.doc	Supporting Statement A	Uploaded 2012-06-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201002	Questionnaire	Other-WORD	New
201001	Opening Statement	Other-WORD	New
201000	Recuritment Script	Other-WORD	New

ICR Details

OMB Control No: 0920-0936	ICR Reference No: 201202-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Validation of an Occupational Safety and Health Questionnaire
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
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/03/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2013	12 Months From Approved
Responses	1,800	0	0
Time Burden (Hours)	810	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In order to better understand some of the factors that may be contributing to the persistent occupational health disparities between Latino immigrant and American-born workers, NIOSH is developing a questionnaire that focuses on important occupational safety and health issues such as risk perception, risk acceptance and workplace coping strategies. The results of this project will benefit Latino immigrant workers by validating a method for increasing the effectiveness of their occupational safety and health training. The results of this project could be used by the federal agencies to determine guidelines for the development of culturally appropriate training materials for Latino workers.

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Authorizing Statute(s): US Code: 29 USC 669 Name of Law: OSH 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 40918	07/12/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4045	01/26/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Opening Statement
Questionnaire
Recuritment Script

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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	1,800	0	0	1,800	0	0
Annual Time Burden (Hours)	810	0	0	810	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 collection request for a new OMB Control Number.

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Annual Cost to Federal Government: $149,841

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: 02/03/2012

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