Request for Non-substantive Change
Workplace Violence Prevention Programs in NJ Healthcare Facilities
OMB Approval #0920-0914 – Expiration date 05/31/2019
Justification for Non-substantive change:
We are requesting a change to the method of collecting the survey data to an online survey due to difficulty recruiting nursing home workplace violence prevention committee chairs to do an in person interview.
The requested change will not change the following: the scope of the study, the survey questions, the respondents, the burden hours, and the use of the data.
Burden table submitted to OMB:
Respondents |
Form Name |
No. of Respondents |
No. of Responses per Respondent |
Average Burden per Response (in hrs) |
Total Burden (in hrs) |
Nursing Home Administrators |
Evaluation of Nursing Home Workplace Violence Prevention Program: Abstraction Form |
20 |
1 |
1 |
20 |
Nursing Home Administrators |
Committee Chair Interview |
20 |
1 |
1 |
20 |
Nursing Home Administrators |
Employee Incident Form |
20 |
1 |
1 |
20 |
Total |
|
60 |
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | CDC User |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |