OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201110-0920-010 · OMB 0920-0914 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Nurse Survey Form New Repair queued
Incident Information Form New Available
Interview - Committee Chair Form New Repair queued
Evaluation Form - Administrators Form New Repair queued
10 7 2011 NJ Project Section B_Ridenour.doc Supporting Statement B Uploaded 2011-10-13 Repair queued
Appendix I.docx Supplementary Document Uploaded 2011-10-13 Repair queued
Appendix H.docx Supplementary Document Uploaded 2011-10-13 Repair queued
Appendix G.docx Supplementary Document Uploaded 2011-10-13 Repair queued
HSRB 11-DSR-02XP 092111 approval RidenourM wkplace vio.pdf Supplementary Document Uploaded 2011-10-13 Available
60 day FRN.pdf Supplementary Document Uploaded 2011-10-13 Repair queued
Appendix A.docx Supplementary Document Uploaded 2011-10-13 Repair queued
Appendix F updated 9.30.11.docx Supplementary Document Uploaded 2011-10-13 Repair queued
Appendix D updated 9.30.11.docx Supplementary Document Uploaded 2011-10-13 Available
10 11 2011 Workplace Violence Prevention Programs- Sec A.docx Supporting Statement A Uploaded 2011-10-13 Available
IC Document Collections
IC IDCollectionTypeStatusForm
199796 Nurse Survey Form New
199795 Incident Information Form New
199794 Interview - Committee Chair Form New
199793 Evaluation Form - Administrators Form New
ICR Details
0920-0914 201110-0920-010
Historical Active
HHS/CDC
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 01/16/2012
Retrieve Notice of Action (NOA) 10/20/2011
Approved consistent with the understanding that any changes made to the Nurses Survey based on the pilot test will be submitted to OMB for approval (either a revision or a non-substantive change, depending on the extent of changes) prior to implementation of the full study.
  Inventory as of this Action Requested Previously Approved
01/31/2015 36 Months From Approved
2,150 0 0
817 0 0
0 0 0
CDC's National Institute for Occupational Safety and Health (NIOSH) seeks clearance to conduct research on the prevention of workplace violence in the healthcare industry. The objective of this project is to evaluate the impact of the New Jersey Violence Prevention in Health Care Facilities Act.
PL: Pub.L. 91 - 596 20.a.1 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  76 FR 40916 07/12/2011
76 FR 64351 10/18/2011
Yes
  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 2,150 0 0 2,150 0 0
Annual Time Burden (Hours) 817 0 0 817 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection request.
$831,088
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Daniel Holcomb 770 488-4472 [email protected]
  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.
10/20/2011