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Federal forms, ICRs, and supporting documents

Information Collection Request

Survey of Work-Relaed Assaults Treated in Hospital Emergency Departments

ICR 200211-0920-003 · OMB 0920-0575 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
7030 Survey of Work-Relaed Assaults Treated in Hospital Emergency Departments Migrated
ICR Details
0920-0575 200211-0920-003
Historical Active
HHS/CDC
Survey of Work-Relaed Assaults Treated in Hospital Emergency Departments
New collection (Request for a new OMB Control Number)   No
Emergency 12/24/2002
Approved with change 12/24/2002
Retrieve Notice of Action (NOA) 11/27/2002
Approved for 6 months as an emergency collection. In the future, CDC is expected to determine the need for OMB approval early in the study development phase and provide time for full OMB review. This approval is for a follow-back survey on workplace violence using data on work-related injuries collected under the CPSC NEISS mechanism. CDC has sponsored collection of this data for several years without OMB approval, which is a violation of the Paperwork Reduction Act. CDC is responsible for obtaining OMB approval for the collection of this information, either through a revision of the existing CPSC approval or through a separate CDC information collection request.
  Inventory as of this Action Requested Previously Approved
06/30/2003 06/30/2003
1,600 0 0
533 0 0
0 0 0
As part of a broad-based workplace violence prevention initiative NIOSH proposes to collect information regarding circumstances of nonfatal workplace assaults from workers who sought treatment for such injuries in a sample of U.S. hospital emergency departments. These data, in combination with information collected and analyzed from oher sources, will improve recommendations or preventing violence in the workplace.
None
None
No
1
IC Title Form No. Form Name
Survey of Work-Relaed Assaults Treated in Hospital Emergency Departments
  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 1,600 0 0 1,600 0 0
Annual Time Burden (Hours) 533 0 0 533 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
11/27/2002