Challenge Administrators Survey Supporting Statement

Request for Approval under the “DOL Departmental Generic Clearance for the Collection of
Routine Customer Feedback”
(OMB Control Number: 1225-0088)
TITLE OF INFORMATION COLLECTION: Survey Questionnaire for OSHA Challenge
Administrators
PURPOSE: The purpose of this request for approval is to allow the Occupational Safety and Health
Administration (OSHA), Directorate of Cooperative and State Program (DCSP) to request data from
past and current OSHA Challenge Administrators. Administrators are organizations such as
corporations, non-profit associations, or Federal agencies that have met OSHA criteria including,
dedicated resources to administer the Challenge program for their worksites/members or other
organizations’ worksites/members.
DCSP is attempting to collect data from current and past administrators in order to gauge were to make
improvements to the Challenge Program. If granted approval DCSP would send the nine questions
below to approximately forty-five administrators utilizing survey monkey, an online survey platform.
DESCRIPTION OF RESPONDENTS: OSHA Challenge Administrators. Administrators are
organizations such as corporations, non-profit associations, or Federal agencies that have met OSHA
criteria including, dedicated resources to administer the Challenge program for their
worksites/members or other organizations’ worksites/members.
TYPE OF COLLECTION: (Check one)
[ ] Customer Comment Card/Complaint Form
[ ] Usability Testing (e.g., Website or Software
[ ] Focus Group

[ ] Stakeholders Satisfaction Survey
[ ] Small Discussion Group
[X] Other: Stakeholder feedback

CERTIFICATION:
I certify the following true:
1. The collection is voluntary.
2. The collection is low-burden for respondents and low-cost for the Federal Government.
3. The collection is non-controversial and does not raise issues of concern to other federal agencies.
4. The results are not intended to be disseminated to the public.
5. Information gathered will not be used for substantially informing influential policy decisions.
6. The collection is targeted to the solicitation of opinions from respondents who have experience
with the program or may have experience with the program in the future.
Name: ________________________________________________
Kelly C. Knighton

August 18, 2020

To assist review, please provide answers to the following question:
Personally Identifiable Information:
1. Is personally identifiable information (PII) collected? [ ] Yes [ X] No
2. If yes, is the information that will be collected included in records that are subject to the Privacy
Act of 1974? [ ] Yes [ ] No
3. If Applicable, has a System or Records Notice been published? [ ] Yes [X ] No
Gifts or Payments:

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Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to
participants? [ ] Yes [X] No
BURDEN HOURS
Category Of Number of
Respondent Respondents

Total
Number of
Responses

Participation Total
Time
Burden
(In hrs.)
Hours

Stakeholders 45

Number of
Responses
Per
Respondent
1

45

.75

34

Totals

1

45

.75

34

45

FEDERAL COST: The estimated annual cost to the Federal government is GS-13 Step/10 3-hours
($192.50)
If you are conducting a focus group, survey, or plan to employ statistical methods, please provide
answers to the following questions:
The selection of your targeted respondents
1. Do you have a customer list or something similar that defines the universe of potential respondents
and do you have a sampling plan for selecting from this universe?
[ X] Yes
[ ] No
If the answer is yes, please provide a description of both below (or attach the sampling plan)? OSHA
is using a list of all the former and current OSHA Challenge Administrators. There is no sampling plan
because we plan to contact all administrators identified on the list.
Administration of the Instrument
1. How will you collect the information? (Check all that apply)
[ ] Web-based or other forms of Social Media
[ ] Telephone
[ ] In-person
[ ] Mail
[X] Other, utilizing survey monkey, an online survey platform. Will interviewers or facilitators
be used? [ ] Yes [X] No

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