OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201206-0920-003 · OMB 0920-0914 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Nurse Survey Form Modified Repair queued
Incident Information Form Modified Repair queued
Interview - Committee Chair Form Modified Repair queued
Evaluation Form - Administrators Form Modified Available
OMB Change 6.6.2012.doc Justification for No Material/Nonsubstantive Change Uploaded 2012-06-12 Repair queued
Reminder Letter Changes 6 11 2012 (6).docx Supplementary Document Uploaded 2012-06-12 Repair queued
Introduction Letter Clean 6 6 2012.docx Supplementary Document Uploaded 2012-06-12 Repair queued
Final LetterChanges 6 11 2012.docx Supplementary Document Uploaded 2012-06-12 Available
Appendix D updated 9.30.11.docx Supplementary Document Uploaded 2011-10-13 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
199796 Nurse Survey Form Modified
199795 Incident Information Form Modified
199794 Interview - Committee Chair Form Modified
199793 Evaluation Form - Administrators Form Modified
ICR Details
0920-0914 201206-0920-003
Historical Active 201206-0920-001
HHS/CDC
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/15/2012
Retrieve Notice of Action (NOA) 06/15/2012
  Inventory as of this Action Requested Previously Approved
01/31/2015 01/31/2015 01/31/2015
4,150 0 4,150
1,483 0 1,483
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
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 4,150 4,150 0 0 0 0
Annual Time Burden (Hours) 1,483 1,483 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$831,088
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Walker 4046394773
  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.
06/15/2012