Assessment of Ill Worker Policies Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Restaurant Environment Observation Form	Form	New	Repair queued
Restaurant Environment Observation Form	Form	New	Available
Restaurant Environment Observation Form	Form	New	Available
Food Worker Consent and Survey	Form	New	Available
Food Worker Consent and Survey	Form	New	Available
Food Worker Consent and Survey	Form	New	Available
Manager Consent and Interview	Form	New	Available
Manager Consent and Interview	Form	New	Available
Manager Consent and Interview	Form	New	Available
Restaurant Environment Observation Form	Form	New	Available
Restaurant Environment Observation Form	Form	New	Available
Food Worker Consent and Survey	Form	New	Available
Food Worker Consent and Survey	Form	New	Available
Manager Consent and Interview	Form	New	Repair queued
Manager Consent and Interview	Form	New	Available
SSA Ass ILL Wrkr Plcy_Clean.docx	Supporting Statement A	Uploaded 2018-05-07	Available
Att 11 Ill worker protocol.docx	Supplementary Document	Uploaded 2017-11-08	Available
Att 10 RDF EHSnet Ill Worker Policy Study-OS.pdf	Supplementary Document	Uploaded 2017-11-08	Available
Att 9 Guide To Dvlpng A Rst Ill Wrkr Mgt Plan.docx	Supplementary Document	Uploaded 2017-11-08	Available
Att 3b EHS-Net Publications.docx	Supplementary Document	Uploaded 2017-11-08	Available
Att 3a EHS-Net Industry Partners.doc	Supplementary Document	Uploaded 2017-11-08	Available
Att 2 60dayFRNAsssmnt Ill Wrkr Plcy Stdy.pdf	Supplementary Document	Uploaded 2017-11-08	Available
Att 1 Authorizing Legislation.pdf	Supplementary Document	Uploaded 2017-11-08	Available
SSB Ass Ill Wrkr Plcy Stdy.doc	Supporting Statement B	Uploaded 2017-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
228972	Restaurant Environment Observation - Control Visit 3	Form	New	Restaurant Environment Observation Form
228971	Restaurant Environment Observation - Control Visit 2	Form	New	Restaurant Environment Observation Form
228970	Restaurant Environment Observation - Control Visit 1	Form	New	Restaurant Environment Observation Form
228969	Food Worker Consent and Survey - Control Visit 3	Form	New	Food Worker Consent and Survey
228968	Food Worker Consent and Survey - Control Visit 2	Form	New	Food Worker Consent and Survey
228967	Food Worker Consent and Survey - Control Visit 1	Form	New	Food Worker Consent and Survey
228966	Manager Consent and Interview - Control Visit 3	Form	New	Manager Consent and Interview
228965	Manager Consent and Interview - Control Visit 2	Form	New	Manager Consent and Interview
228964	Manager Consent and Interview - Control Visit 1	Form	New	Manager Consent and Interview
228963	Restaurant Environment Observation - Intervention Visit 2	Form	New	Restaurant Environment Observation Form
228962	Restaurant Environment Observation - Intervention Visit 1	Form	New	Restaurant Environment Observation Form
228961	Food Worker Consent and Survey - Intervention Visit 2	Form	New	Food Worker Consent and Survey
228960	Food Worker Consent and Survey - Intervention Visit 1	Form	New	Food Worker Consent and Survey
228959	Manager Consent and Interview - Intervention Visit 2	Form	New	Manager Consent and Interview
228958	Manager Consent and Interview - Intervention Visit 1	Form	New	Manager Consent and Interview
228957	Manager Recruiting Script	Other-Telephone script	New

ICR Details

OMB Control No: 0920-1227	ICR Reference No: 201711-0920-008
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-17AMO
Title: Assessment of Ill Worker Policies Study
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: 05/07/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/13/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved
Responses	2,127	0	0
Time Burden (Hours)	352	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Environmental Health Specialists Network (EHS-Net) program, conducts research designed to identify and understand environmental factors associated with foodborne illness and other food safety issues. The purpose of this data collection is to assess whether an educational intervention will result in restaurants developing enhanced ill worker management plans to keep an ill food worker away from work and reduce the risk of transmission of illness from that worker to the public.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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:
	82 FR 32551	07/14/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 52049	11/09/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 16

table that charts list of burden

IC Title	Form No.	Form Name
Food Worker Consent and Survey - Control Visit 1	none	Food Worker Consent and Survey
Food Worker Consent and Survey - Control Visit 2	none	Food Worker Consent and Survey
Food Worker Consent and Survey - Control Visit 3	none	Food Worker Consent and Survey
Food Worker Consent and Survey - Intervention Visit 1	none	Food Worker Consent and Survey
Food Worker Consent and Survey - Intervention Visit 2	none	Food Worker Consent and Survey
Manager Consent and Interview - Control Visit 1	none	Manager Consent and Interview
Manager Consent and Interview - Control Visit 2	none	Manager Consent and Interview
Manager Consent and Interview - Control Visit 3	none	Manager Consent and Interview
Manager Consent and Interview - Intervention Visit 1	none	Manager Consent and Interview
Manager Consent and Interview - Intervention Visit 2	none	Manager Consent and Interview
Manager Recruiting Script
Restaurant Environment Observation - Control Visit 1	none	Restaurant Environment Observation Form
Restaurant Environment Observation - Control Visit 2	none	Restaurant Environment Observation Form
Restaurant Environment Observation - Control Visit 3	none	Restaurant Environment Observation Form
Restaurant Environment Observation - Intervention Visit 1	none	Restaurant Environment Observation Form
Restaurant Environment Observation - Intervention Visit 2	none	Restaurant Environment Observation Form

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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	2,127	0	0	2,127	0	0
Annual Time Burden (Hours)	352	0	0	352	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 ICR.

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Annual Cost to Federal Government: $119,333

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 11/13/2017

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