OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH)

ICR 201501-0920-025 · OMB 0920-0940 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Local Health Department and th HHE Program Brochure Survey Form New Available
NIOSH HHE SS Part B_FAST TRACK.docx Supporting Statement B Uploaded 2015-01-29 Available
NIOSH HHE SS Part A 1 21 14.docx Supporting Statement A Uploaded 2015-01-29 Available
Draft Generic Clearance Submission Template - 4-11.docx Supplementary Document Uploaded 2012-05-14 Available
IC Document Collections
IC IDCollectionTypeStatusForm
226270 Interviews with Restaurant Owners about Knowledge and Attitudes towards Work-Related Musculoskeletal Disorders Prevention Other-Interview Script New
225028 Local Health Department and th HHE Program Brochure Survey Form New
ICR Details
0920-0940 201501-0920-025
Historical Active 201205-0920-005
HHS/CDC
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIOSH)
Extension without change of a currently approved collection   No
Regular
Approved without change 03/20/2015
Retrieve Notice of Action (NOA) 02/04/2015
OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.
  Inventory as of this Action Requested Previously Approved
03/31/2018 36 Months From Approved 06/30/2015
1,000 0 1,000
800 0 800
0 0 0
This collection of information is necessary to enable the Agency to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.
PL: Pub.L. 91 - 596 19 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  79 FR 24432 04/30/2014
80 FR 5760 02/03/2015
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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 800 800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$187,500
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Carol Marsh 404 639-4773 [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.
02/04/2015