Field Test for Safety and Health Programs Mini Supporting Statement

Request for Approval under the “DOL Departmental Generic Clearance for the Collection of Routine Customer Feedback”

(OMB Control Number: 1225-0088)

TITLE OF INFORMATION COLLECTION:

Field Test for Safety and Health Programs

PURPOSE:

The purpose of this request for approval under the existing generic clearance 1225-0088 is for a survey to determine the usefulness of a voluntary, step-by-step, web-based field test of worksheets and resources created to help support or build safety and health programs. OSHA wants to solicit feedback to learn about the specific experiences of individuals after reviewing and completing the worksheets. Information collected will ensure that these products meet the participant's needs and improve as needed. 

DESCRIPTION OF RESPONDENTS:

The field test will target individuals from the public, emphasizing workers and employers from various industries.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is a low burden for respondents and a low cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.                                                                                        

4. OSHA will not disseminate the results to the public.         

5. Information gathered will not be used to inform effective policy decisions substantially.

6. The collection is targeted at soliciting opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:_Pamela Barclay _____________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System of Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

OSHA Anticipates it will take respondents 5-10 minutes, with an average of 7 minutes, to complete the survey

Category of Respondent	No. of Respondents	Participation Time (in hours)	Burden
Field test participants	500	(7/60 minutes) 0.116666667 h	58
Totals	500		58

Cost to the respondent: $0.00

Cost to the Federal Government: $0.00

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan). If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

We will be advertising the availability of the field test through communications listservs, during outreach meetings and presentations, and through OSHA field personnel. The survey is open to anyone who chooses to respond.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X ] Web-based or other forms of Social Media (100%)

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ X ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.