Assessment of Ill Worker Policies Study

Forms and Documents

Document Name	Status
Resaturant intervention log - control restaurants Form and Instruction	Unchanged
Restaurant intervention log - intervention restaurants Form	Unchanged
Form 0920-1227 Manager Consent and Interview - control restaurants Form and Instruction	Modified
Restaurant Observation Form and Instruction	Unchanged
Manager Consent and Interview Form and Instruction	Modified
Manager Recruiting Script Form and Instruction	Unchanged
Ill Worker Protocol (body) 220223.docx Supplementary Document	2022-04-18
OMB non-substantive change request.docx Justification for No Material/Nonsubstantive Change	2022-04-18
P_Att 6 Participation Log 201211.xlsx Supplementary Document	2021-01-13
P_Att 5a Sick Food Worker Toolkit 201211.docx Supplementary Document	2021-01-13
P_Att 1 Study Advertisement Template 201211.docx Supplementary Document	2021-01-13
Ill Worker Protocol (body) 201211.docx Supplementary Document	2021-01-13
App F STARS Determination.pdf Supplementary Document	2021-01-13
App E Privacy Impact Assessment.pdf Supplementary Document	2021-01-13
App D EHS-Net Publications.docx Supplementary Document	2021-01-13
App C EHS-Net Industry Partners.docx Supplementary Document	2021-01-13
App B 60-day FRN 200914.pdf Supplementary Document	2021-01-13
App A Authorizing Legislation.pdf Supplementary Document	2021-01-13
1 - SSB Ass Ill Wrkr Plcy 201211.docx Supporting Statement B	2021-01-13
1 - SSA Ass Ill Wrkr Plcy 201228.docx Supporting Statement A	2021-01-13

IC Document Collections

IC ID	Document Title	Status
245317	Resaturant intervention log - control restaurants Form and Instruction	Unchanged
245315	Restaurant intervention log - intervention restaurants Form	Unchanged
228964	Manager Consent and Interview - control restaurants Form and Instruction	Modified
228962	Restaurant Observation Form and Instruction	Unchanged
228958	Manager Consent and Interview Form and Instruction	Modified
228957	Manager Recruiting Script Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1227	ICR Reference No: 202204-0920-004
Status: Received in OIRA	Previous ICR Reference No: 202101-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1227-22ED
Title: Assessment of Ill Worker Policies Study
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/18/2022

	Requested	Previously Approved
Expiration Date	03/31/2024	03/31/2024
Responses	820	820
Time Burden (Hours)	260	260
Cost Burden (Dollars)	0	0

---

Abstract: CDC is requesting to add an additional attachment 3a with a reduced reading level for the consent script at a recipient’s IRB request. Recipient sites will be able to use either form as long as it is approved by their IRB.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 56615	09/14/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 8649	02/08/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Manager Consent and Interview	0920-1227, none	Manager consent and interview ,   Consent to Participate in Human Research Study
Manager Consent and Interview - control restaurants	0920-1227	Consent to Participate in Human Research Study
Manager Recruiting Script	none	Manager recruiting script
Resaturant intervention log - control restaurants	none	Intervention log - control restaurants
Restaurant Observation	none	Restaurant Observation
Restaurant intervention log - intervention restaurants	none	Restaurant intervention log

---

ICR Summary of Burden

	Total Request	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	820	820	0	0	0	0
Annual Time Burden (Hours)	260	260	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $119,333

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

---

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: 04/18/2022

---