OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202109-0920-012 · OMB 0920-1244 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-1244 Fire Fighters Follow-back Survey Form and Instruction Modified Available
Attachment G PIA_National Electronic Injury Surveillance System (NEISS).pdf Supplementary Document Uploaded 2021-09-29 Repair queued
Attachment F- IRB.pdf Supplementary Document Uploaded 2021-09-29 Missing upstream
Attachment E_protocol.docx Supplementary Document Uploaded 2021-09-29 Missing upstream
Attachment D FF Pre_Interview_Consent_Letter.docx Supplementary Document Uploaded 2021-09-29 Missing upstream
Attachment A_OSH Act.docx Supplementary Document Uploaded 2021-09-29 Available
Attachment B FF 60-day FRN.pdf Supplementary Document Uploaded 2021-09-29 Repair queued
FF_ICR_SupportingStatement_B Sept_2021_final.docx Supporting Statement B Uploaded 2021-09-29 Repair queued
FF_ICR_SupportingStatement_A Sept_2021_final.docx Supporting Statement A Uploaded 2021-09-29 Available
IC Document Collections
IC IDCollectionTypeStatusForm
231809 Fire Fighters Follow-back Survey Form and Instruction Modified
ICR Details
0920-1244 202109-0920-012
Received in OIRA 201806-0920-005
HHS/CDC 0920-1244
Assessment of Occupational Injury among Fire Fighters Using a Follow-back Survey
Extension without change of a currently approved collection   No
Regular 10/13/2021
  Requested Previously Approved
12 Months From Approved 10/31/2021
35 240
18 120
454 2,915
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. This extension is requested to collect data for one more year.
PL: Pub.L. 91 - 596 20 Name of Law: OSH Act
  
None
Not associated with rulemaking
  86 FR 38100 07/19/2021
86 FR 56958 10/13/2021
No
1
IC Title Form No. Form Name
Fire Fighters Follow-back Survey 0920-1244 Fire Fighter Follow-back Survey revised
  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 35 240 0 -205 0 0
Annual Time Burden (Hours) 18 120 0 -102 0 0
Annual Cost Burden (Dollars) 454 2,915 0 -2,461 0 0
No
Yes
Miscellaneous Actions
The decrease is due to the request to extend the collection one more year to collect info from a small number of respondents.
$66,804
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
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.
10/13/2021