Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0834 Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey	Form and Instruction	Modified	Available
EMS_ICR_Section_B revised 090910_120430.doc	Supporting Statement B	Uploaded 2012-08-02	Available
Attachment G.doc	Supplementary Document	Uploaded 2012-08-02	Available
Attachment F_090910.docx	Supplementary Document	Uploaded 2012-08-02	Available
Attachment E.doc	Supplementary Document	Uploaded 2012-08-02	Available
Attachment C.doc	Supplementary Document	Uploaded 2012-08-02	Repair queued
Attachment H.docx	Supplementary Document	Uploaded 2012-08-02	Available
EMS_ICR_Section_A revised 120713.doc	Supporting Statement A	Uploaded 2012-08-02	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
191021	Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0834	ICR Reference No: 201208-0920-004
Status: Historical Active	Previous ICR Reference No: 200910-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/01/2012
	Date Received in OIRA: 08/09/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	24 Months From Approved	12/31/2012
Responses	150	0	175
Time Burden (Hours)	50	0	58
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this project is to conduct research to provide a detailed description of non-fatal occupational injuries and illnesses incurred by emergency medical services (EMS) workers. This project will use two related data sources. The first source is data abstracted from medical records of EMS workers treated in a nationally stratified sample of emergency departments (ED). These data are routinely collected by the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work). The second data source, for which the National Institute for Occupational Safety and Health (NIOSH) is seeking OMB approval, involves data collected from telephone interview surveys of injured EMS workers identified within NEISS-Work.

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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:
	77 FR 30014	05/21/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 47074	08/07/2012
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
Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey	0920-0834	EMS Worker Notification Form

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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	150	175	0	0	-25	0
Annual Time Burden (Hours)	50	58	0	0	-8	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: For this revision request, the data collected to-date were used to produce an updated estimate of the number of completed interviews to be obtained each year. The data collected thus far indicate we will collect approximately 150 interviews annually. This is a reduction from the previous estimate of 175 that was extrapolated based on routine NEISS-Work surveillance data from earlier years. This reduction resulted in a decrease in the respondent burden hours from 58 to 50.

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Annual Cost to Federal Government: $75,000

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: 08/09/2012

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