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: 6/7/2013

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 2/29/2016. Our changes are as follows: (1). Home Healthcare Aide Survey – added Are you currently working as a home healthcare aide in New Jersey? on page 1. (2). Switched the Background section (now last) and the Violence-Based Safety Programs in Health Care section (now first). (3). Added a second column in the Experienced Violent Events section; added from patient or family member and from coworker or boss. (4). Added a second column in the Health Promotion section; added Wellness classes offered by agency? And Participated in wellness classes offered by agency? (5). For the Background section, added age ranges; deleted job type; added agency question; changed Employment Status to hours worked with ranges; deleted month from Experience; added Which Employers do you work for? with categories to select.

Justification of change for the home healthcare aide survey: the screener question allows us to capture home health care aides that work only in a New Jersey. The changes 2-5 came after the home healthcare aide survey was pilot tested with home healthcare aides. The home healthcare aide survey does not change in length at four pages.

The requested changes will not change the scope of the study and the burden hours will not change.