Evaluating the Effectiveness of Occupational Safety and Health Program Elements in theWholesale Retail Sector

Forms and Documents

Document Name	Status
Non-Respondent Follow-up Interview Form and Instruction	New
INFORMED CONSENT TO PARTICIPATE IN A LEADING INDICATORS BENCHMARKING RESEARCH PROJECT Form and Instruction	New
Occupational Safety and Health Program Evaluation Survey Year1 Form and Instruction	New
Supplemental Document Responses.docx Supplementary Document	2012-09-26
BLISS Survey Appearance on Qualtrics.docx Supplementary Document	2012-09-26
Section B OSH program 6_11_12.docx Supporting Statement B	2012-06-20
Attachment A Authorizing Legislation 5_8_12.docx Supplementary Document	2012-06-20
Attachment K OSH Prgm SampleSize Requirements 5_08_12.docx Supplementary Document	2012-06-20
Attachment J SurveySampling Strategy 5_08_12.docx Supplementary Document	2012-06-20
Attachment F information Security Plan 5_08_12.docx Supplementary Document	2012-06-20
Attachment E- US Census Bureau comparison 3 5_08_12.docx Supplementary Document	2012-06-20
Attachment E-2 Letter of support 5_08_12.docx Supplementary Document	2012-06-20
Attachment E-1 NIOSH ltr of Agreement 5_08_12.docx Supplementary Document	2012-06-20
Attachment D-2 Prior OSH Interv Studies 5_08_12.docx Supplementary Document	2012-06-20
Attachment D-1CDC'S Broader Research Agenda 5_08_12.docx Supplementary Document	2012-06-20
Attachment C - Goals's met by Current Proj 5_ 08_12.docx Supplementary Document	2012-06-20
Section A OSH Program 6_11_12.docx Supporting Statement A	2012-06-20

IC Document Collections

IC ID	Document Title	Status
202833	Non-Respondent Follow-up Interview Form and Instruction	New
202832	INFORMED CONSENT TO PARTICIPATE IN A LEADING INDICATORS BENCHMARKING RESEARCH PROJECT Form and Instruction	New
202831	Occupational Safety and Health Program Evaluation Survey Year1 Form and Instruction	New

ICR Details

OMB Control No: 0920-0949	ICR Reference No: 201206-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluating the Effectiveness of Occupational Safety and Health Program Elements in theWholesale Retail Sector
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: 10/22/2012
	Date Received in OIRA: 06/22/2012
Terms of Clearance: Approved consistent with the understanding that the OMB control number along with the standard public burden statement must be displayed on all instruments

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved
Responses	9,600	0	0
Time Burden (Hours)	1,681	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: NIOSH proposes to conduct a study to assess the effectiveness of occupational safety and health (OSH) elements (MSDs) among wholesale/ retail trade (WRT) employers The proposed research involves a firm-level survey of a series of organizational metrics considered to be potential predictors of injury and illness WC claim rates and duration in a stratified sample of Ohio Bureau of Workers Compensation (OBWC)-insured WRT firms in Ohio. There are expected to be up to 4,104 participant firms and surveys will be administered twice to the same firms in successive years (e.g. from January- December 2013 and again from January- December 2014). A nested study at 60 firms will ask multiple respondents at each firm to participate.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20-22 Name of Law: Occupational Safety and Health Act of 1970
  

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:
	77 FR 9929	02/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 37051	06/20/2012
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Occupational Safety and Health Program Evaluation Survey Year1	None, None	Occupational Safety and Health Program Evaluation Survey Year 1 ,   Occupational Safety and Health Program Evaluation Survey Year 2
INFORMED CONSENT TO PARTICIPATE IN A LEADING INDICATORS BENCHMARKING RESEARCH PROJECT	None	INFORMED CONSENT TO PARTICIPATE IN A LEADING INDICATORS BENCHMARKING RESEARCH PROJECT
Non-Respondent Follow-up Interview	None	Non-Respondent Follow-up Interview

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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	9,600	0	0	9,600	0	0
Annual Time Burden (Hours)	1,681	0	0	1,681	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 new ICR

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Annual Cost to Federal Government: $152,454

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]? 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: 06/22/2012

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