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 202110-0920-005 · OMB 0920-1350 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920- Att D18- Serological Sample Form Unchanged Repair queued
Form 0920- Att D17- Civil Unrest Form Unchanged Missing upstream
Form 0920- Att D16- COVID19- Round 2 Form Unchanged Repair queued
Form 0920- Att D15- COVID- Round 1 Form Unchanged Repair queued
Form 0920- Att D14- Beck Hopelessness Form Unchanged Repair queued
Form 0920- Att D13- Beck Depression Form Unchanged Repair queued
Form 0920- Att D12- Pittsburgh Sleep Quality Index Form Unchanged Available
Form 0920- Att D11- Beck Anxiety Form Unchanged Repair queued
Form 0920 Att D10- Connor-Davidson Resiliency Scale Form Unchanged Missing upstream
Form 0920 Att D9- PTSD Form Unchanged Repair queued
Form 0920 Att D8- Fatigue Scale Form Unchanged Repair queued
Form 0920- Att D7- Maslach Burnout Form Unchanged Repair queued
Form 0920 Att D6- Org Support Form Unchanged Repair queued
Form 0920- Att D5_Brief Cope Form Unchanged Repair queued
Form 0920- Att D4- Centers for Epidemiologic Studies Depression Scale Form Unchanged Repair queued
Form 0920- Att H1_Eligibility Screening Form Unchanged Repair queued
Form 0920- Att D3- Spielberger Stress Survey Form Unchanged Repair queued
Form 0920 Att D2- Medical History Form Unchanged Repair queued
Form 0920 Att D1- Personal History Form Unchanged Repair queued
Change Request Memo 12OCT2021.docx Justification for No Material/Nonsubstantive Change Uploaded 2021-10-12 Repair queued
Appendix F2 NIOSH HSRB_non_exempt.pdf Supplementary Document Uploaded 2021-07-28 Repair queued
Appendix F1 UB IRB.docx Supplementary Document Uploaded 2021-07-28 Missing upstream
Appendix E UB Consent Form.docx Supplementary Document Uploaded 2021-07-28 Repair queued
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 Missing upstream
Statement B_revised 092921.docx Supporting Statement B Uploaded 2021-10-12 Repair queued
Statement A_revised 92921.docx Supporting Statement A Uploaded 2021-10-12 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
248601 Att D19- Salivary Cortisol collection Other- Unchanged
248600 Att D18- Serological Sample Form Unchanged
248599 Att D17- Civil Unrest Form Unchanged
248598 Att D16- COVID19- Round 2 Form Unchanged
248597 Att D15- COVID- Round 1 Form Unchanged
248596 Att D14- Beck Hopelessness Form Unchanged
248595 Att D13- Beck Depression Form Unchanged
248594 Att D12- Pittsburgh Sleep Quality Index Form Unchanged
248592 Att D11- Beck Anxiety Form Unchanged
248589 Att D10- Connor-Davidson Resiliency Scale Form Unchanged
248588 Att D9- PTSD Form Unchanged
248587 Att D8- Fatigue Scale Form Unchanged
248586 Att D7- Maslach Burnout Form Unchanged
248585 Att D6- Org Support Form Unchanged
248582 Att D5_Brief Cope Form Unchanged
248581 Att D4- Centers for Epidemiologic Studies Depression Scale Form Unchanged
248580 Att H1_Eligibility Screening Form Unchanged
248579 Att H_Introduction Letter Other-word Unchanged
248575 Att G_Letter of Invitation Other-WORD Unchanged
248340 Att D3- Spielberger Stress Survey Form Unchanged
248339 Att D2- Medical History Form Unchanged
248338 Att D1- Personal History Form Unchanged
ICR Details
0920-1350 202110-0920-005
Received in OIRA 202106-0920-006
HHS/CDC 0920-21CG
A Longitudinal Examination of Mental and Physical Health among Police Associated with COVID–19
No material or nonsubstantive change to a currently approved collection   No
Regular 10/12/2021
  Requested Previously Approved
09/30/2024 09/30/2024
6,580 6,580
596 596
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. This Non-Substantive Change Request is submitted to modify the discussion of incentives in Supporting Statement Part A and the Consent Form so that it matches incentive amounts in Supporting Statement Part B. The Change Request also revises the language in Supporting Statement Parts A and B describing the incentives for this study. Per OMB guidance, NIOSH has removed the term “token of appreciation.” There is no change to the overall burden or instruments associated with the approved study.
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 6,580 0 0 0 0
Annual Time Burden (Hours) 596 596 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new data collection
$796,355
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Jeffrey Zirger 404 639-7118 [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.
10/12/2021