Pilot Study and Prospective Analysis of the Draft Revised Form 33, Safety and Health Program Assessment Worksheet

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 33 On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)	Form and Instruction	New	Available
Form 33 Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction	New	Available
1218-0NEW Supporting Statement A_ROCIS_ 5-17-22.docx	Supporting Statement A	Uploaded 2022-05-17	Repair queued
Draft Revised Form 33 -OSBA no tracked changes 4-28-22 PRA.docx	Supplementary Document	Uploaded 2022-05-03	Repair queued
signed_PRA Signature Form_OSHA_SHP_(2021_1029) (003).pdf	Supplementary Document	Uploaded 2022-04-21	Repair queued
OSHA Act Section 2 USC 651.pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
Section 21(d) of the OSH Act (29 USC 670).pdf	Supplementary Document	Uploaded 2022-03-14	Repair queued
eCFR 29 PART 1908.pdf	Supplementary Document	Uploaded 2022-02-02	Repair queued
1218-0NEW Pilot Study Procedures 100220 (3-22-2021 DCSP-OSBA).docx	Supplementary Document	Uploaded 2022-02-02	Repair queued
1218-0NEW Method_Final_ 9-30-2020 (3-17-2021 DCSP-OSBA).docx	Supplementary Document	Uploaded 2022-02-02	Repair queued
60 day FRN 12-29-21.pdf	Supplementary Document	Uploaded 2022-02-02	Repair queued
1218-0NEW Supporting Statement B _ROCIS_1-24-22.docx	Supporting Statement B	Uploaded 2022-02-02	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
252436	Summary of Estimated Respondent (Employer) Hour and Cost Burden		New
252151	Estimated Respondent (State Consultation Programs) Hour and Cost Burden for the Prospective Analysis		New
252096	Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction	New	On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)
252096	Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	Form and Instruction	New

ICR Details

OMB Control No: 1218-0280	ICR Reference No: 202202-1218-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/OSHA	Agency Tracking No: 1218-0NEW (2022)
Title: Pilot Study and Prospective Analysis of the Draft Revised Form 33, Safety and Health Program Assessment Worksheet
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 without change	Conclusion Date: 06/21/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/19/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2025	36 Months From Approved
Responses	2,139	0	0
Time Burden (Hours)	4,974	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Occupational Safety and Health Administration (OSHA) is requesting approval from the Office of Management and Budget (OMB), pursuant to the Paperwork Reduction Act (PRA), to conduct validity and reliability analyses of a safety and health program (SHP) assessment worksheet, the Draft Revised Form 33 (DRF33), that will replace the current SHP Assessment Worksheet, OSHA Form 33, used by the OSHA On- Site Consultation Program (OMB #1218– 0110). The studies that will be conducted on the DRF33 will enable OSHA to ensure that a valid, reliable, and efficient tool is provided to On-Site Consultation programs in the fifty (50) states, the District of Columbia, and several United States territories to replace the current OSHA Form 33, thereby, enhancing the quality of consultative services. The studies for which OSHA is requesting approval will comprise a pre- test (20 consultation visits; to assess Pilot Study procedures and information technology platform, and correct any issues before launching the Pilot Study), Pilot Study (300 consultation visits; to assess the validity and reliability of the DRF33), a follow-up study (30 consultation visits; to assess any updates to the DRF33 resulting from Pilot Study findings), and a Prospective Analysis (conducted 12 months after the Pilot Study to assess any impact of the DRF33 at workplaces that received consultation visits during the Pilot Study). After completing the Pilot Study, OSHA will request OMB approval before implementing the DRF33 for use by state On-Site Consultation programs nationwide (to replace the current Form 33). Similarly, OSHA will seek OMB approval if any additional updates are made to the approved worksheet, following the Prospective Analysis.

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Authorizing Statute(s): US Code: 29 USC 651 Name of Law: Occupational Safety and Health Act
   US Code: 29 USC 670 Name of Law: Occupational Safety and Health Act
  

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:
	86 FR 74106	12/29/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 30515	05/19/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study	33	On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for the Prospective Analysis
Summary of Estimated Respondent (Employer) Hour and Cost Burden

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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	2,139	0	0	2,139	0	0
Annual Time Burden (Hours)	4,974	0	0	4,974	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 data collection.

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Annual Cost to Federal Government: $139,416

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? No

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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: 05/19/2022

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