OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201507-0920-011 · OMB 0920-0914 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Home Healthcare Aides Survey Form Unchanged Repair queued
Nursing Home Administrators Employee Incident Information Form Unchanged Available
Form 0920-0914 Nursing Home Administrators Survey Form and Instruction Modified Repair queued
Nurse (RN and LPN) Survey Form Unchanged Repair queued
Hospital Administrators Employee Incident Information Form Unchanged Repair queued
Hospital Administrators Committee Chair Interview Form Unchanged Repair queued
Form 0920-0914 Hospital Administrators Evaluation Form Form and Instruction Modified Repair queued
OMB Change 7-21-15-final.doc Justification for No Material/Nonsubstantive Change Uploaded 2015-07-28 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
205005 Home Healthcare Aides Survey Form Unchanged
205004 Nursing Home Administrators Employee Incident Information Form Unchanged
205003 Nursing Home Administrators Committee Chair Interview Other-Interview Unchanged
205002 Nursing Home Administrators Survey Form and Instruction Modified
199796 Nurse (RN and LPN) Survey Form Unchanged
199795 Hospital Administrators Employee Incident Information Form Unchanged
199794 Hospital Administrators Committee Chair Interview Form Unchanged
199793 Hospital Administrators Evaluation Form Form and Instruction Modified
ICR Details
0920-0914 201507-0920-011
Historical Inactive 201403-0920-011
HHS/CDC 15AJV
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
No material or nonsubstantive change to a currently approved collection   No
Regular
Improperly submitted and continue 08/03/2015
Retrieve Notice of Action (NOA) 07/28/2015
  Inventory as of this Action Requested Previously Approved
02/29/2016 02/29/2016 03/31/2016
2,738 0 2,738
960 0 960
0 0 0
NIOSH is requesting a nonmaterial/non-substantive change to our OMB Information Collection Request titled 'Workplace Violence Prevention Programs in NJ Healthcare Facilities' (OMB control number 0920-0914, expiration date 2/29/2016). In order to learn about safety climates in hospitals and nursing homes, we would like to request a change to Attachment C1: Hospital and Nursing Home – Evaluation of Workplace violence Prevention Program. We would like to add the Organizational-level Safety Climate questions (Section I. 1-16) to the data collection instrument.
PL: Pub.L. 91 - 596 20.a.1 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
Yes
Yes
Miscellaneous Actions
No
. The burden hours will increase by 2 hours, going from 960 burden hours to 962 since the safety climate questions (Section I 1-16) take approximately 5 minutes to answer. The interview time went from 60 minutes to 65 minutes (1.08 hours).
$964,367
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Catina Conner 4046394775
  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.
07/28/2015