Musculoskeletal Disorder (MSD) Intervention Effectiveness in an Insurer-Supported Engineering Control Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Early Exit Interview	Form and Instruction	New	Available
Self Reported General Work Environment and Heath Questionnaire	Form and Instruction	New	Available
Self-Reported Specific Job Tasks and Safety Incidents Questionnaire	Form and Instruction	New	Available
Self-Reported Shoulder/Arm Pain Questionnaire	Form and Instruction	New	Available
Self-Reported Low Back Pain Questionnaire	Form and Instruction	New	Available
Early Exit Interview	Form and Instruction	Modified	Available
Form 7 Low Back Functional Assessment	Form and Instruction	Removed	Available
Self-Reported General Workk Environment and Health Questionnaire	Form and Instruction	Modified	Available
Self-Reported Specific Job Tasks and Safety Incidents Questionnaire	Form and Instruction	Modified	Available
Self-Reported Shoulder/Arm Pain Questionnaire	Form and Instruction	Modified	Available
Self-Reported Low Back Pain Questionnaire	Form and Instruction	Modified	Available
Form 2 Informed Consent- Low Back Functional Assessment	Form and Instruction	Removed	Available
Informed Consent	Form and Instruction	Modified	Available
Attachment L-5 Study Limitations.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment L-3 MSD Study Outcomes.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment L-1 Interventions.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment K IRB Approval.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment J-4 Indiv Recruitment Flyer.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment J-3 OBWC Safety Grant 2.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment J-2 OBWC Safety Grant 1.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment J-1 Recruitment Flyer.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment G-3 Photograph Consent.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment G-1 Informed Consent.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment F Information Security.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment E-3 US_Ohio Codes.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment E-2 OBWC Letter of Support.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment E-1 OBWC_NIOSH Agreement.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment D-2 MSD Intervention Studies.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment D-1 Relation to CDC Research.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment C NIOSH Strategic Goals.docx	Supplementary Document	Uploaded 2014-09-10	Available
Attachment B 60d FRN.pdf	Supplementary Document	Uploaded 2014-09-10	Available
Attachment A Authorizing Legislation.docx	Supplementary Document	Uploaded 2014-09-10	Repair queued
Section B MSD Intervention 2_10_15.docx	Supporting Statement B	Uploaded 2015-02-13	Available
Section A MSD Intervention 2_09_15.docx	Supporting Statement A	Uploaded 2015-02-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215010	Early Exit Interview - Additional Data Collection	Form and Instruction	New	Early Exit Interview
215007	Self-Reported General Work Environment and Health Questionnaire - Additional Data Collection	Form and Instruction	New	Self Reported General Work Environment and Heath Questionnaire
215006	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire - Additional Data Collection	Form and Instruction	New	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire
215005	Self-Reported Shoulder/Arm (Upper Extremity) Pain Questionnaire - Additional Data Collection	Form and Instruction	New	Self-Reported Shoulder/Arm Pain Questionnaire
215004	Self-Reported Low Back Questionnaire - Additional Data Collection	Form and Instruction	New	Self-Reported Low Back Pain Questionnaire
198869	Early Exit Interview - Original Data Collection	Form and Instruction	Modified	Early Exit Interview
198868	Low Back Functional Assessment	Form and Instruction	Removed	Low Back Functional Assessment
198867	Self-Reported General Work Environment and Health Questionnaire - Original Data Collection	Form and Instruction	Modified	Self-Reported General Workk Environment and Health Questionnaire
198866	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire - Original Data Collection	Form and Instruction	Modified	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire
198865	Self-Reported Shoulder/Arm (Upper Extremity) Pain Questionnaire - Original Data Collection	Form and Instruction	Modified	Self-Reported Shoulder/Arm Pain Questionnaire
198864	Self-Reported Low Back Pain Questionnaire - Original Data Collection	Form and Instruction	Modified	Self-Reported Low Back Pain Questionnaire
198863	Informed Consent- Low Back Functional Assessment	Form and Instruction	Removed	Informed Consent- Low Back Functional Assessment
198862	Informed Consent (Questionnaire Data Collection)	Form and Instruction	Modified	Informed Consent

ICR Details

OMB Control No: 0920-0907	ICR Reference No: 201409-0920-008
Status: Historical Active	Previous ICR Reference No: 201108-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Musculoskeletal Disorder (MSD) Intervention Effectiveness in an Insurer-Supported Engineering Control Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/02/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/17/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	24 Months From Approved	03/31/2015
Responses	4,154	0	15,701
Time Burden (Hours)	382	0	1,500
Cost Burden (Dollars)	0	0	0

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Abstract: NIOSH proposes a revision to continue conducting a study in partnership with the Ohio Bureau of Workers Compensation (OBWC) to assess the effectiveness of occupational safety and health interventions for musculoskeletal disorders. This revision will allow a previously approved data collection to be completed on currently participating employers/employees (using a previously approved protocol) and allow new employers/employees to be enrolled (using a modified protocol). The original protocol uses a randomized control design where 33 employers were matched based on the similarity of employee tasks, prior loss history, and the affected number of employees prior to the intervention being into place. The main outcomes are self-reported back and upper extremity pain among employees performing material handling operations. To complete the data collection on the 103 currently employees using the original protocol, 292 remaining surveys need to be completed, requiring 21 additional months. NIOSH is also requesting approval of a modified protocol moving forward to allow new employers and up to 200 employees to be enrolled for an additional 2 year study. The new study design still involves collecting symptoms at baseline before the intervention and after the intervention is put into place. However, the protocol is modified from the original data collection in that 1) all employers will now receive the intervention immediately, rather than half being randomly selected to receive the intervention six months later; 2) a low back functional assessment is no longer being conducted; and 3) the study population now includes employees performing material handling and patient handling tasks in all industries. These changes were necessary because the expansion of the OBWC intervention program inadvertently removed some incentives to participate in the original study. OBWC asked NIOSH to continue to measure the effectiveness of the program in terms of employee symptoms and other detailed measures because the new expansion gives the opportunity to increase the generalizability of study findings to a greater variety of industries, including health care, and tasks, including patient handling.

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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:
	79 FR 32299	06/04/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 54982	09/15/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Early Exit Interview - Additional Data Collection	None	Early Exit Interview
Early Exit Interview - Original Data Collection	None	Early Exit Interview
Informed Consent (Questionnaire Data Collection)	None	Informed Consent
Informed Consent- Low Back Functional Assessment	2	Informed Consent- Low Back Functional Assessment
Low Back Functional Assessment	7	Low Back Functional Assessment
Self-Reported General Work Environment and Health Questionnaire - Additional Data Collection	None	Self Reported General Work Environment and Heath Questionnaire
Self-Reported General Work Environment and Health Questionnaire - Original Data Collection	None	Self-Reported General Workk Environment and Health Questionnaire
Self-Reported Low Back Pain Questionnaire - Original Data Collection	None	Self-Reported Low Back Pain Questionnaire
Self-Reported Low Back Questionnaire - Additional Data Collection	None	Self-Reported Low Back Pain Questionnaire
Self-Reported Shoulder/Arm (Upper Extremity) Pain Questionnaire - Additional Data Collection	None	Self-Reported Shoulder/Arm Pain Questionnaire
Self-Reported Shoulder/Arm (Upper Extremity) Pain Questionnaire - Original Data Collection	None	Self-Reported Shoulder/Arm Pain Questionnaire
Self-Reported Specific Job Tasks and Safety Incidents Questionnaire - Additional Data Collection	None	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire
Self-Reported Specific Job Tasks and Safety Incidents Questionnaire - Original Data Collection	None	Self-Reported Specific Job Tasks and Safety Incidents Questionnaire

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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	4,154	15,701	0	-11,547	0	0
Annual Time Burden (Hours)	382	1,500	0	-1,118	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: NIOSH has removed a Low Back Functional Assessment Questionnaire and Informed Consent Form resulting in a decrease in Burden Hours.

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Annual Cost to Federal Government: $25,050

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: 09/17/2014

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