OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19

ICR 202106-0920-006 · OMB 0920-1350 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920- Att D18- Serological Sample Form New Repair queued
Form 0920- Att D17- Civil Unrest Form New Repair queued
Form 0920- Att D16- COVID19- Round 2 Form New Missing upstream
Form 0920- Att D15- COVID- Round 1 Form New Missing upstream
Form 0920- Att D14- Beck Hopelessness Form New Repair queued
Form 0920- Att D13- Beck Depression Form New Repair queued
Form 0920- Att D12- Pittsburgh Sleep Quality Index Form New Missing upstream
Form 0920- Att D11- Beck Anxiety Form New Repair queued
Form 0920 Att D10- Connor-Davidson Resiliency Scale Form New Repair queued
Form 0920 Att D9- PTSD Form New Repair queued
Form 0920 Att D8- Fatigue Scale Form New Repair queued
Form 0920- Att D7- Maslach Burnout Form New Repair queued
Form 0920 Att D6- Org Support Form New Available
Form 0920- Att D5_Brief Cope Form New Repair queued
Form 0920- Att D4- Centers for Epidemiologic Studies Depression Scale Form New Repair queued
Form 0920- Att H1_Eligibility Screening Form New Repair queued
Form 0920- Att D3- Spielberger Stress Survey Form New Repair queued
Form 0920 Att D2- Medical History Form New Missing upstream
Form 0920 Att D1- Personal History Form New Repair queued
Appendix F2 NIOSH HSRB_non_exempt.pdf Supplementary Document Uploaded 2021-07-28 Missing upstream
Appendix F1 UB IRB.docx Supplementary Document Uploaded 2021-07-28 Repair queued
Appendix E UB Consent Form.docx Supplementary Document Uploaded 2021-07-28 Missing upstream
Appendix C Examination Components.docx Supplementary Document Uploaded 2021-07-02 Repair queued
Appendix B _60dy2121CG.FRN.pdf Supplementary Document Uploaded 2021-07-02 Repair queued
Appendix A.docx Supplementary Document Uploaded 2021-07-02 Repair queued
SSB (0920-21CG).docx Supporting Statement B Uploaded 2021-07-02 Repair queued
SSA (0920-21CG).docx Supporting Statement A Uploaded 2021-07-02 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
248601 Att D19- Salivary Cortisol collection Other- New
248600 Att D18- Serological Sample Form New
248599 Att D17- Civil Unrest Form New
248598 Att D16- COVID19- Round 2 Form New
248597 Att D15- COVID- Round 1 Form New
248596 Att D14- Beck Hopelessness Form New
248595 Att D13- Beck Depression Form New
248594 Att D12- Pittsburgh Sleep Quality Index Form New
248592 Att D11- Beck Anxiety Form New
248589 Att D10- Connor-Davidson Resiliency Scale Form New
248588 Att D9- PTSD Form New
248587 Att D8- Fatigue Scale Form New
248586 Att D7- Maslach Burnout Form New
248585 Att D6- Org Support Form New
248582 Att D5_Brief Cope Form New
248581 Att D4- Centers for Epidemiologic Studies Depression Scale Form New
248580 Att H1_Eligibility Screening Form New
248579 Att H_Introduction Letter Other-word New
248575 Att G_Letter of Invitation Other-WORD New
248340 Att D3- Spielberger Stress Survey Form New
248339 Att D2- Medical History Form New
248338 Att D1- Personal History Form New
ICR Details
202106-0920-006
Received in OIRA
HHS/CDC 0920-21CG
A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19
New collection (Request for a new OMB Control Number)   No
Regular 07/29/2021
  Requested Previously Approved
36 Months From Approved
6,580 0
596 0
0 0
The overarching goal of this study is to evaluate the longitudinal consequences of the COVID-19 pandemic on the mental and physical health of police officers. This data will consist of markers of disease such as blood pressure, measurement of lipids, glucose, and insulin, measurement of body fat and salivary cortisol. Psychosocial factors detrimental to health such as perceived stress, work stress, depression, as well as protective factors (e.g. resiliency and coping) will also be examined.
US Code: 29 USC 699 Name of Law: the Occupational Safety and Health Act
  
None
Not associated with rulemaking
  86 FR 7095 01/26/2021
86 FR 35295 07/02/2021
Yes
  Total Request 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 6,580 0 0 6,040 540 0
Annual Time Burden (Hours) 596 0 0 548 48 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new data collection
$796,355
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
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.
07/29/2021