OMB Change 7-21-15-final

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]

304-285-58794

Date: 7/17/2015

Re: Nonmaterial/non-substantive Change to OMB 0920-0914

NIOSH is requesting a nonmaterial/non-substantive change to our OMB Information Collection Request titled ‘Workplace Violence Prevention Programs in NJ Healthcare Facilities’ (OMB control number 0920-0914, expiration date 2/29/2016). In order to learn about safety climates in hospitals and nursing homes, we would like to request a change to Attachment C1: Hospital and Nursing Home – Evaluation of Workplace violence Prevention Program. We would like to add the Organizational-level Safety Climate questions (Section I. 1-16) to the data collection instrument.

The requested changes will not change the scope of the study. The burden hours will increase by 2 hours, going from 960 burden hours to 962 since the safety climate questions (Section I 1-16) take approximately 5 minutes to answer. The interview time went from 60 minutes to 65 minutes (1.08 hours).

Estimated annualized Burden Hours

Respondents	Form Name	No. of Respondents	No. of Responses per Respondent	Average Burden per Response (in hrs)	Total Burden (in hrs)
Hospital Administrators	Evaluation of Hospital Workplace Violence Prevention Program (C1)	17	1	1.08	18
Hospital Administrators	Committee Chair Interview (C2)	17	1	1	17
Hospital Administrators	Employee Incident Information (C3)	17	1	1	17
Nursing Home Administrators	Evaluation of Nursing Home Workplace Violence Prevention Program (C1)	7	1	1.08	8
Nursing Home Administrators	Committee Chair Interview (C2)	7	1	1	7
Nursing Home Administrators	Employee Incident Information (C3)	7	1	1	7
Nurses (RN and LPN)	Healthcare Facility Workplace Violence Prevention Programs Nurse  Survey (C4)	1333	1	20/60	444
Home Healthcare Aides	Healthcare Facility Workplace Violence Prevention Programs Home Healthcare Aide Survey (C5)	1333	1	20/60	444
Total		962