OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201510-0920-006 · OMB 0920-0914 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Home Healthcare Aides Survey Form Removed Available
Nursing Home Administrators Committee Chair Interview Form Modified Repair queued
Nursing Home Administrators Committee Chair Interview Form Modified Repair queued
Nursing Home Administrators Survey Form Modified Available
Nurse (RN and LPN) Survey Form Removed Available
Hospital Administrators Employee Incident Information Form Removed Available
Hospital Administrators Committee Chair Interview Form Removed Available
Hospital Administrators Evaluation Form Form Removed Repair queued
Appendix G .docx Supplementary Document Uploaded 2015-10-26 Repair queued
Appendix F.docx Supplementary Document Uploaded 2015-10-26 Repair queued
Att E IRB.pdf Supplementary Document Uploaded 2015-10-26 Repair queued
Appendix D.docx101915.docx Supplementary Document Uploaded 2015-10-26 Repair queued
Att B 60-Day.pdf Supplementary Document Uploaded 2015-10-26 Available
Appendix A.docx Supplementary Document Uploaded 2015-10-26 Available
Responses Statement B revised_3.23.docx Supporting Statement B Uploaded 2016-03-23 Repair queued
Responses Statement A revised_3.23.docx Supporting Statement A Uploaded 2016-03-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
205005 Home Healthcare Aides Survey Form Removed
205004 Nursing Home Administrators Committee Chair Interview Form Modified
205003 Nursing Home Administrators Committee Chair Interview Form Modified
205002 Nursing Home Administrators Survey Form Modified
199796 Nurse (RN and LPN) Survey Form Removed
199795 Hospital Administrators Employee Incident Information Form Removed
199794 Hospital Administrators Committee Chair Interview Form Removed
199793 Hospital Administrators Evaluation Form Form Removed
ICR Details
0920-0914 201510-0920-006
Historical Active 201403-0920-011
HHS/CDC
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
Revision of a currently approved collection   No
Regular
Approved with change 03/24/2016
Retrieve Notice of Action (NOA) 11/04/2015
Approved consistent with the understanding that the following limitations will be addressed in any publications or presentations: 1) most of the information will be collected through self-report, which could lead to reporting bias and the misclassification of the presence of workplace violence prevention program components; 2) differential response rates between New Jersey and Virginia could introduce a bias; 3) assessment of the quality of the components will not be conducted.
  Inventory as of this Action Requested Previously Approved
03/31/2018 24 Months From Approved 03/31/2016
60 0 2,738
60 0 960
0 0 0
This is an intervention evaluation study to compare the comprehensiveness of nursing home workplace violence prevention programs in New Jersey to those in Virginia. This revision is to complete, and add, nursing home interviews and drop the nursing home administrator employee incident information form. The remainder of the study was completed over the past three years.
PL: Pub.L. 91 - 596 20.a.1 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  80 FR 16391 03/27/2015
80 FR 65763 10/27/2015
No
  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 60 2,738 0 -2,678 0 0
Annual Time Burden (Hours) 60 960 0 -900 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
Most of the information collection for this study was completed over the past three years of approval. This revision request is for 2 years to complete, and add, nursing home administrator interviews, and to drop the Employee Incident Information Form. There is a decrease in burden due to completed collections, and a slight increase as 20 additional nursing homes are included.
$19,612
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [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.
11/04/2015