OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessment of Occupational Injury among Fire Fighters Using a Follow-back Survey

ICR 201806-0920-005 · OMB 0920-1244 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-18LQ Fire Fighters Follow-back Survey Form and Instruction New Available
Responses to comments on OMB package_FF Survey.docx Supplementary Document Uploaded 2018-10-05 Available
PIA_National Electronic Injury Surveillance System (NEISS).pdf Supplementary Document Uploaded 2018-10-05 Repair queued
Attachment D_Pre_Interview_Consent_Letter_OMB_Clean.docx Supplementary Document Uploaded 2018-10-05 Available
Firefighter_PIA.PDF Supplementary Document Uploaded 2018-07-03 Available
Attachment G_60_Day FRN_Comments.docx Supplementary Document Uploaded 2018-06-13 Available
Attachment F 17-DSR-05XP Initial Approval Memo Lifting Site Restriction 2017.pdf Supplementary Document Uploaded 2018-06-13 Available
Attachment E Survey Protocol.docx Supplementary Document Uploaded 2018-06-13 Available
Attachment D_Pre_Interview_Consent_Letter.docx Supplementary Document Uploaded 2018-06-13 Available
Attachment A_OSH Act.doc Supplementary Document Uploaded 2018-06-13 Available
Attachment B 60day FRN.pdf Supplementary Document Uploaded 2018-06-13 Available
FF_ICR_Section_B May112018_OMB_Clean.doc Supporting Statement B Uploaded 2018-10-05 Available
FF_ICR_Section_A Sept 28_clean.doc Supporting Statement A Uploaded 2018-10-05 Available
IC Document Collections
IC IDCollectionTypeStatusForm
231809 Fire Fighters Follow-back Survey Form and Instruction New
ICR Details
0920-1244 201806-0920-005
Active
HHS/CDC 0920-18LQ
Assessment of Occupational Injury among Fire Fighters Using a Follow-back Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 10/10/2018
Retrieve Notice of Action (NOA) 07/05/2018
  Inventory as of this Action Requested Previously Approved
10/31/2021 36 Months From Approved
240 0 0
120 0 0
2,915 0 0
The purpose of this project is to describe nonfatal occupational injuries and exposures of fire fighters treated in a nationally stratified sample of emergency departments. Data will be collected via telephone interviews. Results will offer insight into characteristics of fire fighters' injuries and exposures in an effort to reduce the number of injuries and exposures in this important workforce.
PL: Pub.L. 91 - 596 20 Name of Law: OSH Act
  
None
Not associated with rulemaking
  83 FR 6185 02/13/2018
83 FR 26690 06/08/2018
Yes
1
IC Title Form No. Form Name
Fire Fighters Follow-back Survey 0920-18LQ Fire Fighter Follow-back Survey revised
  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 240 0 0 240 0 0
Annual Time Burden (Hours) 120 0 0 120 0 0
Annual Cost Burden (Dollars) 2,915 0 0 2,915 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$91,471
Yes Part B of Supporting Statement
    No
    No
No
No
No
Uncollected
Kevin Joyce 404 639-1944 [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.
07/05/2018