OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

ICR 201802-0920-010 · OMB 0920-0914 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0914 Nursing Home Administrators Committee Chair Interview Form Modified Available
Form 0920-0914 Nursing Home Administrators Committee Chair Interview Form Modified Available
Form 0920-0914 Nursing Home Administrators Survey Form Modified Available
Appendix G.rtf Supplementary Document Uploaded 2018-03-26 Available
Appendix F.pdf Supplementary Document Uploaded 2018-03-26 Available
Appendix E.pdf Supplementary Document Uploaded 2018-02-26 Available
Appendix D.docx Supplementary Document Uploaded 2018-03-26 Repair queued
Appendix B.pdf Supplementary Document Uploaded 2018-02-26 Available
Appendix A.docx Supplementary Document Uploaded 2018-03-26 Available
Supporting Statement B 3.26.18.doc Supporting Statement B Uploaded 2018-03-26 Available
Sup Sta A 0920-0914 3.28.18.docx Supporting Statement A Uploaded 2018-03-28 Available
IC Document Collections
IC IDCollectionTypeStatusForm
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
ICR Details
0920-0914 201802-0920-010
Historical Active 201510-0920-006
HHS/CDC 0920-0914
Workplace Violence Prevention Programs In New Jersey Healthcare Facilities
Extension without change of a currently approved collection   No
Regular
Approved without change 05/01/2018
Retrieve Notice of Action (NOA) 03/28/2018
Previous terms continue: 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 mis-classification 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
05/31/2019 12 Months From Approved 04/30/2018
60 0 60
60 0 60
0 0 0
This project is an intervention evaluation study, comparing the comprehensiveness of nursing home workplace violence prevention programs in New Jersey (NJ) with the comprehensiveness of programs in Virginia (VA). The purpose of the information collected is to disseminate the information to health departments for potential development of legislation for a workplace violence prevention programs.
PL: Pub.L. 91 - 596 20.a.1 Name of Law: Occupational Safety and Health Act
  
None
Not associated with rulemaking
  82 FR 55611 11/22/2017
83 FR 12764 03/23/2018
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 60 60 0 0 0 0
Annual Time Burden (Hours) 60 60 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Thelma Sims 4046394771
  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.
03/28/2018