Justification for Change

DEPARTMENT OF HEALTH & HUMAN SERVICES Public Health Service

________________________________________________________________________________________

Centers for Disease Control

 and Prevention (CDC)

National Institute for Occupational

 Safety and Health (NIOSH)

1095 Willowdale Road, MS1811

Morgantown, WV 26505-2888

PHONE: (304) 285-5913

FAX: (304) 285-6235

To: Office of Management and Budget

From: Marilyn Lou Ridenour, BSN, MBA, MPH

CDC/NIOSH

1095 Willowdale Road MS 1811

Morgantown, WV 26505

[email protected]

304-285-5879

Date: 6/6/2012

Re: Nonmaterial/non-substantive Change to OMB 0920-0914

We are requesting a nonmaterial/non-substantive change to our OMB Approved Information Collection titled ‘Workplace Violence Prevention Programs in NJ Healthcare Facilities’ (OMB control number 0920-0914) with expiration date 1/31/2015. Our changes are as follows: (1). Nurse Survey – added Do you work in a New Jersey healthcare facility? on page 1. (2). Nurse Survey Letters – added salutations, minimal risk, and contact information for the NIOSH HSRB chair to the Introduction Letter, Reminder Letter, and Final Letter. We added information regarding the nurse survey to the Reminder Letter and Final Letter.

Justification of change for the nurse survey: the screener question allows us to capture registered nurses (RNs) and licensed practical nurses (LPNs) that work only in a New Jersey healthcare facility. These changes came after a meeting with our contractor. The nurse survey does not change in length at four pages.

Justification of change of nurse survey letters: provides a concise introduction letter, reminder letter (2^nd mailing of nurse survey), and final letter (3^rd mailing of nurse survey). They provide the same information regarding the nurse survey. The requested changes will not change the scope of the study.

Attachment: Nurse Survey 6.5.2012 (clean copy), Introduction Letter, Reminder Letter, Final Letter