Information Collection

[2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum

IC 254736 under ICR 201912-0920-003 · OMB 0920-1154.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1154 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Safety Skills at Work Pre-Survey [2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum	Form and Instruction
Safety Skills at Work Post-Survey [2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum	Form and Instruction
Safety Skills at Work Follow-up Survey [2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum	Form and Instruction
Safety Skills at Work Post-Training Feedback Session Questions [2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum	Form and Instruction
Safety Skills at Work Pre-Survey Attachment D- Pre-Survey.docx	Form and Instruction
Safety Skills at Work Post-Survey Attachment E- Post-Survey.docx	Form and Instruction
Safety Skills at Work Follow-up Survey Attachment F- Follow-up Survey.docx	Form and Instruction
Safety Skills at Work Post-Training Feedback Session Que Attachment G- Post-Training Feedback Session Questions.docx	Form and Instruction
Supporting Statement A_07-19-22.docx Supporting Statement Part A	IC Document
Supporting Statement B_07-18-22.docx Supporting Statement Part B	IC Document
Attachment A- OSH Act.docx Authorizing Legislation: Occupational Safety and Health Act	IC Document
Attachment B- Draft Main Curriculum Document.docx Safety Skills at Work: Main Curriculum Document (draft)	IC Document
Attachment C- Draft PowerPoint Slides.pptx Safety Skills at Work: PowerPoint Presentation (draft)	IC Document
Attachment H- IRB Nonresearch Determination.pdf CDC Determination: IRB Approval is Not Required	IC Document
Attachment I- Recruitment Script.docx Recruitment Script	IC Document
Attachment J- Consent Script.docx Consent Script	IC Document
Attachment K- Emails to Confirm Pilot Details.docx Emails to Confirm Participation Details	IC Document
Attachment L- Survey Admininistration Emails.docx Survey Administration Emails	IC Document
Attachment M- Survey Reminder Emails.docx Survey Reminder Emails	IC Document
Attachment N- Flowchart of Steps for Each Cohort.docx Flowchart of Steps for Each Cohort	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

[2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum

Agency IC Tracking Number:

0920-1154-21GU

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable
Form and Instruction	None	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 72

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	72	72
Annual IC Time Burden (Hours)	84	84
Annual IC Cost Burden (Dollars)	2,178	2,178

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement Part A		07/19/2022
Supporting Statement Part B		07/19/2022
Authorizing Legislation: Occupational Safety and Health Act		07/19/2022
Safety Skills at Work: Main Curriculum Document (draft)		07/19/2022
Safety Skills at Work: PowerPoint Presentation (draft)		07/19/2022
CDC Determination: IRB Approval is Not Required		07/19/2022
Recruitment Script		07/19/2022
Consent Script		07/19/2022
Emails to Confirm Participation Details		07/19/2022
Survey Administration Emails		07/19/2022
Survey Reminder Emails		07/19/2022
Flowchart of Steps for Each Cohort		07/19/2022

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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