Research to Inform the Prevention of Asthma in Healthcare

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Respiratory Therapists - Telephone Survey	Form	New	Available
Registered Nurses - Telephone Survey	Form	New	Available
Operating Room Technicians - Telephone Survey	Form	New	Available
Lab Technicians - Telephone Survey	Form	New	Available
Licensed Practical Nurses - Telephone Survey	Form	New	Available
Environmental Service Workers - Telephone Survey	Form	New	Available
Dental Assistants - Telephone Survey	Form	New	Available
Central Supply Workers - Telephone Survey	Form	New	Available
Certified Nursing Assistants - Telephone Survey	Form	New	Available
Respiratory Therapist - Online Survey	Form	New	Available
Registered Nurses - Online Survey	Form	New	Available
Operating Room Technicians - Online Survey	Form	New	Available
Lab Technicians - Online Survey	Form	New	Available
Licensed Practical Nurses - Online Survey	Form	New	Available
Environmental Service Workers - Online Survey	Form	New	Repair queued
Dental Assistants - Online Survey	Form	New	Available
Central Supply Workers - Online Survey	Form	New	Available
Certified Nursing Assistants - Online Survey	Form	New	Available
Appendix_O_8.23.13.docx	Supplementary Document	Uploaded 2013-09-05	Available
OMB_PartB_9 4 13.docx	Supporting Statement B	Uploaded 2013-09-05	Available
Appendix I_(3).docx	Supplementary Document	Uploaded 2013-04-10	Available
Appendix N_(3).docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix H_(3).docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix_G_(2).docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix F_(3).docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix E_(3).docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix D.pdf	Supplementary Document	Uploaded 2013-04-09	Available
Appendix C- public comment.docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix B 60day FRN.pdf	Supplementary Document	Uploaded 2013-04-09	Available
Appendix A.docx	Supplementary Document	Uploaded 2013-04-09	Available
Appendix L_(3).doc	Supplementary Document	Uploaded 2013-04-10	Available
Appendix J_(3.docx	Supplementary Document	Uploaded 2013-04-10	Available
OMB_PartA_Final_Update.docx	Supporting Statement A	Uploaded 2013-09-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206611	Respiratory Therapists - Telephone Survey	Form	New
206610	Registered Nurses - Telephone Survey	Form	New
206609	Operating Room Technicians - Telephone Survey	Form	New
206608	Lab Technicians - Telephone Survey	Form	New
206607	Licensed Practical Nurses - Telephone Survey	Form	New
206606	Environmental Service Workers - Telephone Survey	Form	New
206605	Dental Assistants - Telephone Survey	Form	New
206604	Central Supply Workers - Telephone Survey	Form	New
206603	Certified Nursing Assistants - Telephone Survey	Form	New
206602	Respiratory Therapist - Online Survey	Form	New
206601	Registered Nurses - Online Survey	Form	New
206600	Operating Room Technicians - Online Survey	Form	New
206599	Lab Technicians - Online Survey	Form	New
206598	Licensed Practical Nurses - Online Survey	Form	New
206597	Environmental Service Workers - Online Survey	Form	New
206596	Dental Assistants - Online Survey	Form	New
206595	Central Supply Workers - Online Survey	Form	New
206594	Certified Nursing Assistants - Online Survey	Form	New

ICR Details

OMB Control No: 0920-0983	ICR Reference No: 201304-0920-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 19260
Title: Research to Inform the Prevention of Asthma in Healthcare
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: 09/06/2013
	Date Received in OIRA: 04/19/2013
Terms of Clearance: Approved consistent with the understanding that, as a cohort study, the results will add to the general literature on this topic, but alone cannot be the basis of conclusions about the industry as a whole.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	24 Months From Approved
Responses	2,503	0	0
Time Burden (Hours)	1,255	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Institute for Occupational Safety and Health (NIOSH) is requesting to field a survey to identify modifiable risk factors for asthma among workers in the healthcare industry.

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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 35405	06/13/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 21126	04/09/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 18

table that charts list of burden

IC Title	Form No.	Form Name
Dental Assistants - Telephone Survey	none	Telephone Survey
Environmental Service Workers - Telephone Survey	none	Telephone Survey
Certified Nursing Assistants - Online Survey	none	Survey Web version
Central Supply Workers - Online Survey	none	Online Survey
Dental Assistants - Online Survey	none	Online Survey
Environmental Service Workers - Online Survey	none	Online Survey
Licensed Practical Nurses - Online Survey	none	Online Survey
Lab Technicians - Online Survey	none	Online Survey
Operating Room Technicians - Online Survey	none	Online Survey
Registered Nurses - Online Survey	none	Online Survey
Respiratory Therapist - Online Survey	none	Online Survey
Certified Nursing Assistants - Telephone Survey	none	Telephone Survey
Central Supply Workers - Telephone Survey	none	Telephone Survey
Licensed Practical Nurses - Telephone Survey	none	Telephone Survey
Lab Technicians - Telephone Survey	none	Telephone Survey
Operating Room Technicians - Telephone Survey	none	Telephone Survey
Registered Nurses - Telephone Survey	none	Telephone Survey
Respiratory Therapists - Telephone Survey	none	Telephone Survey

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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	2,503	0	0	2,503	0	0
Annual Time Burden (Hours)	1,255	0	0	1,255	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 information collection request.

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Annual Cost to Federal Government: $712,358

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: 04/19/2013

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