Fire Fighter Fatality Investigation and Prevention Program Survey

Forms and Documents

Document Name	Status
Form 0920-22DW Company Officers Form and Instruction	New
Form 0920-22DW Fire Chiefs Form and Instruction	New
Form 0920-22DW Firefighters Form and Instruction	New
Att2a. Survey Screenshot.docx Supplementary Document	2022-07-26
Att3. Invite-Phone Script .docx Supplementary Document	2022-07-26
Att4. FFFIPP Survey Invite-Email .docx Supplementary Document	2022-07-26
Att5. Survey Invitation.docx Supplementary Document	2022-07-26
Att6. Data Confidentiality.docx Supplementary Document	2022-07-26
Att7.IRB Determination.pdf Supplementary Document	2022-07-26
Att8. FFFIPP Survey Reminder.docx Supplementary Document	2022-07-26
Att9. FFFIPP Sampling Plan.docx Supplementary Document	2022-07-26
Att2. 60-day FRN.pdf Supplementary Document	2022-07-26
Att10. Recruitment Dissemination Plan.pptx Supplementary Document	2022-07-26
Att1. Authorizing legislation.docx Supplementary Document	2022-07-26
NIOSH FFFIPP OMB_Statement B_053122.docx Supporting Statement B	2022-07-26
NIOSH FFFIPP OMB_Statement A_060122.docx Supporting Statement A	2022-07-26

IC Document Collections

IC ID	Document Title	Status
254853	Company Officers Form and Instruction	New
254852	Fire Chiefs Form and Instruction	New
254851	Firefighters Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202207-0920-010
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22DW
Title: Fire Fighter Fatality Investigation and Prevention Program Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/26/2022

	Requested	Previously Approved
Expiration Date	12 Months From Approved
Responses	13,500	0
Time Burden (Hours)	4,050	0
Cost Burden (Dollars)	0	0

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Abstract: The Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) seeks approval from the Office of Management and Budget (OMB) to conduct an evaluation of fire department implementation of the NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). This is a new Information Collection Request (ICR), with approval requested for one-year post-approval date.

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Authorizing Statute(s): None

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:
	87 FR 4894	01/31/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 41318	07/12/2022
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Company Officers	0920-22DW	Att1b. FFFIPP Survey-Officer
Fire Chiefs	0920-22DW	Att1c. FFFIPP Survey-Chief
Firefighters	0920-22DW	Att1a. FFFIPP Survey-Firefighter

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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	13,500	0	0	13,500	0	0
Annual Time Burden (Hours)	4,050	0	0	4,050	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: The Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of FF LODD and recommends ways to prevent deaths and injuries. An estimated 13,500 respondents are anticipated to participate in the survey; the annual respondent burden is estimated to be 4,050 hours.

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Annual Cost to Federal Government: $178,937

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? 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: 07/26/2022

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