OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201212-0920-001 · OMB 0920-0914 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Home Healthcare Aides Survey Form New Repair queued
Nursing Home Administrators Employee Incident Information Form New Repair queued
Nursing Home Administrators Survey Form New Repair queued
Nurse (RN and LPN) Survey Form Modified Repair queued
Hospital Administrators Employee Incident Information Form Modified Repair queued
Hospital Administrators Committee Chair Interview Form Modified Repair queued
Hospital Administrators Evaluation Form Form Modified Repair queued
Supporting Statement Part B.doc Supporting Statement B Uploaded 2012-11-26 Available
Appendix H 11.1.2012.docx Supplementary Document Uploaded 2012-11-27 Available
Appendix G.docx Supplementary Document Uploaded 2012-11-27 Repair queued
Appendix F3.docx Supplementary Document Uploaded 2012-11-27 Available
Appendix F2.docx Supplementary Document Uploaded 2012-11-27 Repair queued
Appendix F1.docx Supplementary Document Uploaded 2012-11-27 Available
Appendix D.docx Supplementary Document Uploaded 2012-11-27 Available
Appendix E HSRB 11.1.12.rtf Supplementary Document Uploaded 2012-11-27 Repair queued
Appendix I- public comment.docx Supplementary Document Uploaded 2012-11-26 Available
Appendix B 60day FRN.pdf Supplementary Document Uploaded 2012-11-26 Available
Appendix A.docx Supplementary Document Uploaded 2012-11-26 Available
Supporting Statement Part A.docx Supporting Statement A Uploaded 2012-11-27 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
205005 Home Healthcare Aides Survey Form New
205004 Nursing Home Administrators Employee Incident Information Form New
205003 Nursing Home Administrators Committee Chair Interview Other-Interview New
205002 Nursing Home Administrators Survey Form New
199796 Nurse (RN and LPN) Survey Form Modified
199795 Hospital Administrators Employee Incident Information Form Modified
199794 Hospital Administrators Committee Chair Interview Form Modified
199793 Hospital Administrators Evaluation Form Form Modified
ICR Details
0920-0914 201212-0920-001
Historical Active 201206-0920-003
HHS/CDC
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
Revision of a currently approved collection   No
Regular
Approved with change 02/04/2013
Retrieve Notice of Action (NOA) 12/03/2012
  Inventory as of this Action Requested Previously Approved
02/29/2016 36 Months From Approved 01/31/2015
2,738 0 4,150
960 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
  77 FR 45617 08/01/2012
77 FR 70781 11/27/2012
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 2,738 4,150 0 1,354 -2,766 0
Annual Time Burden (Hours) 960 1,483 0 465 -988 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The currently approved burden was over-estimated (not annualized), and annualization now results in a burden decrease. This request for revision adds two new respondent groups, resulting in an increase in burden.
$964,367
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.
12/03/2012