VOLUNTARY COVID-19 ATTESTATION FORM FOR MEAT AND POULTRY PROCESSING INDUSTRY EMPLOYERS

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 COVID-19 Attestation Form	Form	New	Repair queued
1218-0NEW Memo to OCIO 05.17.20 Attestation emergency PRA request FINAL.docx	Supplementary Document	Uploaded 2020-05-18	Repair queued
1218-0NEW SSA _Supporting Statement - Emergency Clearance for Attestation COVID-19 FINAL 5.17.2020.docx	Supporting Statement A	Uploaded 2020-05-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241849	COVID-19 Attestation Form	Form	New

ICR Details

OMB Control No:	ICR Reference No: 202005-1218-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: DOL/OSHA	Agency Tracking No: 1218-0NEW COVID-19.1
Title: VOLUNTARY COVID-19 ATTESTATION FORM FOR MEAT AND POULTRY PROCESSING INDUSTRY EMPLOYERS
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/18/2020
OIRA Conclusion Action: Withdrawn	Conclusion Date: 07/17/2020
	Date Received in OIRA: 05/18/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		6 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This is a new ICR being submitted for the information collected from an Attestation Form in furtherance of the OSH Act and the President’s policy goals expressed in Executive Order 13917. The Department requests EMERGENCY CLEARANCE pursuant to 5 CFR 1320.13. The recent outbreaks of COVID–19 among workers at some processing facilities have raised concerns about continued worker exposure in that industry and led to the reduction in some of those facilities’ production capacity. In response, OSHA and CDC jointly issued guidance to the meat and poultry processing industry on April 26, 2020, identifying protocols and practices for employers in that industry to prevent, monitor, and document any COVID-19 cases among workers. Shortly after, the President issued Executive Order 13917 (April 28, 2020), which specifically calls for the continued operation of meat and poultry facilities “consistent with the guidance for the operations of meat and poultry processing facilities jointly issued by the CDC and OSHA.” OSHA plans to provide an “Attestation Form” to employers in the meat and poultry processing industry. Using this form, employers could voluntarily attest to OSHA that they are maintaining protocols and practices in accordance with the OSH Act, OSHA regulations, and the recent OSHA/CDC guidance to the meat and poultry processing industry. Food Safety Inspection Service (FSIS) will distribute with the form a letter explaining the purpose of the form and providing instructions to employers.

Emergency Justfication: OSHA plans to provide an “Attestation Form” to employers in the meat and poultry processing industry. Using this form, employers could voluntarily attest to OSHA that they are maintaining protocols and practices in accordance with the OSH Act, OSHA regulations, and the recent OSHA/CDC guidance to the meat and poultry processing industry. Because of the rapid spread of COVID-19 and the urgency for exposure reduction, OSHA is requesting emergency approval to distribute the Attestation Form, accompanied by an instruction letter to employers.

---

Authorizing Statute(s): EO: EO 13917 Name/Subject of EO: Defense Production Act
   US Code: 29 USC 651 Name of Law: OSH Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
COVID-19 Attestation Form	1	COVID-19 Attestation Form

---

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 emergency request.

---

Annual Cost to Federal Government: $12,693

Does this IC contain surveys, censuses, or employ statistical methods? No

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? Yes

---

Common Form ICR:  No

---

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: 05/18/2020

---