Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-0953)

T ITLE OF INFORMATION COLLECTION: Focus groups to obtain input from retail employers and employees

PURPOSE: The Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), National Center for Productive Aging and Work (NCPAW), seeks approval from the Office of Management and Budget (OMB) to obtain focus group input from retail employers and workers of diverse ages to identify common themes in their experiences with NIOSH products and their communication preferences for dissemination of products about work-related musculoskeletal disorders (WMSDs) due to manual material handling and slips, trips and falls (STFs). This project is the second phase of a larger project that aims to develop a suite of communication products that present solutions to common WMSDs due to manual material handling and STFs in the retail sector. The National Center for Productive Aging and Work (NCPAW) is a virtual center within the National Institute for Occupational Safety and Health (NIOSH) that advances lifelong well-being for workers of all ages and supports productive aging across the working life. In part, NCPAW’s mission is to enhance aging-related research in occupational safety and health, and to develop and promote a broad range of translational products and resources that target workers, organizations, and sectors where aging issues are particularly salient.

DESCRIPTION OF RESPONDENTS:

Four of the focus groups will consist of employees in the retail sector in different age groups while two focus groups will consist of employers in large and small businesses.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[X ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be 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 the purpose of 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:___Harpriya Kaur, PhD_____________________________________________

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, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ X ] Yes [ ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Average Burden per Response (in hours)	Total Burden Hours
Older (55 years and older) workers in small businesses	12	1	1.5	18
Young and middle-aged workers (less than 55 years and old) in small businesses	12	1	1.5	18
Older workers (55 years and older) in large businesses	12	1	1.5	18
Young and middle-aged workers (less than 55 years and old) in larger businesses	12	1	1.5	18
Retail trade employers/managers in large businesses	12	1	1.5	18
Retail trade employers/managers in small businesses	12	1	1.5	18
Total	108

FEDERAL COST: The estimated annual cost to the Federal government is $37,056 (total cost of the contract)

Item Description	Payment per task*
Task 1: Develop project plan and recruitment plan for focus group sessions.	20% of total
Task 2: Prepare interview protocol for each of the six focus groups and conduct one pilot test focus group.	30% of total
Task 3: Conduct six focus groups with up to twelve participants each.	30% of total
Task 4: Conduct analysis of the feedback collected and produce summary report.	20% of total

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? [] Yes [X ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The focus groups will include workers and employers from the retail industry. The contractor will reach out to employers and employees to recruit them for focus group participation. Individuals who would like to volunteer would be selected based on the eligibility criteria of the focus group (age group and occupation). The focus group will have a number of female workers that represent the female proportion of the worker population in the retail sector. The contractor will recruit potential participants from pre-existing lists of personnel; therefore, no new personally identifiable information (PII) will be collected.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ ] Web-based or other forms of Social Media

[ ] Telephone

[X ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X ] Yes [ ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

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. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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