Improving the Health and Safety of the Diverse Workforce

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SS Part B_090712.doc	Supporting Statement B	Uploaded 2012-10-23	Repair queued
Appendix F IRB Letter.pdf	Supplementary Document	Uploaded 2012-10-23	Repair queued
Appendix D- public comment.docx	Supplementary Document	Uploaded 2012-10-23	Repair queued
Appendix B FRN.pdf	Supplementary Document	Uploaded 2012-10-23	Repair queued
Appendix A Legislation.docx	Supplementary Document	Uploaded 2012-10-23	Repair queued
Appendix E _Telephone Intro Script.doc	Supplementary Document	Uploaded 2012-10-24	Repair queued
SS Part A_102412.doc	Supporting Statement A	Uploaded 2012-10-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204689	Telephone Survey	Other-Interview Script	New

ICR Details

OMB Control No:	ICR Reference No: 201211-0920-004
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Improving the Health and Safety of the Diverse Workforce
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/15/2013
	Date Received in OIRA: 11/01/2012
Terms of Clearance: Withdrawn to allow time for the agency to make revisions, consult with the U.S. Department of Labor (DOL/OSHA), and to undertake a pre-test of the methods and survey instrument.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This study entails collecting standardized information from working adults via telephone interview to evaluate: 1) the degree of exposure of minority and non-minority workers to various workplace and job stressors, 2) the impact of these stressors on health and safety outcomes, 3) the organizational characteristics, policies and practices and other factors that protect minority and other workers from stress and associated problems in health and safety.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20 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 28598	05/15/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 65552	10/29/2012
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
Telephone Survey

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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 data collection request.

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Annual Cost to Federal Government: $671,496

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: 11/01/2012

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