[NIOSH] Evaluation of Healthcare Worker Mental Health Campaign

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1415 Hospital Leader - Follow-Up Survey	Form and Instruction	Modified	Available
Hospital Leader - Follow-Up Survey	Form and Instruction	Modified	Available
Hospital Leader - Follow-Up Survey	Form and Instruction	Modified	Repair queued
Form 0920-1415 Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified	Available
Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified	Available
Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified	Repair queued
0920-1415_Evaluation of Healthcare Worker Mental Health Campaign_Revision Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-04-01	Repair queued
2b Responses to Federal Register Notice.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
6 Invitation and Reminder Emails.docx	Supplementary Document	Uploaded 2023-08-03	Repair queued
3 Non-Research Determination.pdf	Supplementary Document	Uploaded 2023-08-03	Repair queued
2a Federal Register Notice.pdf	Supplementary Document	Uploaded 2023-08-03	Repair queued
1b Dr. Lorna Breen Health Care Provider Protection Act.pdf	Supplementary Document	Uploaded 2023-08-03	Repair queued
1a H.R.1319 American Rescue Plan Act of 2021.pdf	Supplementary Document	Uploaded 2023-08-03	Repair queued
Supporting Statement B_NIOSH Health Worker MH Campaign_2.16.23.docx	Supporting Statement B	Uploaded 2023-08-03	Repair queued
Supporting Statement A_NIOSH Health Worker MH Campaign_2.16.22.docx	Supporting Statement A	Uploaded 2023-08-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
261471	Hospital Leader - Follow-Up Survey	Form and Instruction	Modified	Hospital Leader - Follow-Up Survey
261471	Hospital Leader - Follow-Up Survey	Form and Instruction	Modified	Hospital Leader - Follow-Up Survey
261471	Hospital Leader - Follow-Up Survey	Form and Instruction	Modified
261470	Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified	Healthcare Worker - Follow-Up Survey
261470	Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified	Healthcare Worker - Follow-Up Survey
261470	Healthcare Worker - Follow-Up Survey	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1415	ICR Reference No: 202404-0920-001
Status: Historical Active	Previous ICR Reference No: 202308-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1415-24EI
Title: [NIOSH] Evaluation of Healthcare Worker Mental Health Campaign
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/31/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/01/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2024	09/30/2024	09/30/2024
Responses	14,000	0	14,000
Time Burden (Hours)	2,333	0	2,333
Cost Burden (Dollars)	7,508	0	7,508

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Abstract: Proposed study is designed to collect quantitative data to document outcomes of a social marketing campaign to improve the mental health and well-being of healthcare workers (e.g., mental health help seeking, modifications to working conditions, and healthcare worker well-being). Data generated through this information request will inform future campaign efforts that aim to reach healthcare workers and their employers and share findings to advance the health communications, mental health, and occupational health and safety fields. CDC requests OMB approval to collect information from 14,000 respondents for an estimated 2,333 burden hours, annually. This Non-Substantive Change Request is submitted: 1) to modify race/ethnicity questions according to new OMB regulations; and 2) to modify screener questions. There is no change to the burden hours previously approved.

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Authorizing Statute(s): PL: Pub.L. 117 - 2 1-11006 Name of Law: American Rescue Plan Act of 2021
   PL: Pub.L. 117 - 105 1-5 Name of Law: Dr. Lorna Breen Health Care Provider Protection 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:
	87 FR 56593	09/16/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 24800	04/24/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Healthcare Worker - Follow-Up Survey	NA, 0920-1415	Healthcare Worker - Follow-Up Survey ,   Healthcare Worker - Follow-Up Survey
Hospital Leader - Follow-Up Survey	NA, 0920-1415	Hospital Leader - Follow-Up Survey ,   Hospital Leader - Follow-Up Survey

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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	14,000	14,000	0	0	0	0
Annual Time Burden (Hours)	2,333	2,333	0	0	0	0
Annual Cost Burden (Dollars)	7,508	7,508	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:

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Annual Cost to Federal Government: $473,878

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: 04/01/2024

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