Using a Reader Response Card to Assess Worker Notification Materials

Forms and Documents

Document Name	Status
Form 0920-0566 Evaluation of Worker Notification Program Response Card Form and Instruction	Modified
Attachment A.docx Supplementary Document	2012-07-13
60-day FRN.pdf Supplementary Document	2012-07-13
New Supporting Statement B.docx Supporting Statement B	2012-08-02
Attach D- Sample Letter.docx Supplementary Document	2012-04-25
Attach E- Beryllium fact sheet.pdf Supplementary Document	2012-04-25
Attach F- HSRB.docx Supplementary Document	2012-04-25
New Supporting Statement A.docx Supporting Statement A	2012-08-02

IC Document Collections

IC ID	Document Title	Status
7019	Evaluation of Worker Notification Program Response Card Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0566	ICR Reference No: 201205-0920-006
Status: Historical Active	Previous ICR Reference No: 200712-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Using a Reader Response Card to Assess Worker Notification Materials
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/02/2012
	Date Received in OIRA: 05/17/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved
Responses	8,000	0	0
Time Burden (Hours)	1,333	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Since 1977, NIOSH has been developing methods and materials for the notification of subjects of its epidemiological studies. To assess the effectiveness of the notification materials and to improve future communication of risk information, the evaluation instrument proposed (a reader response evaluation card) was developed for routine use.

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Authorizing Statute(s): US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 4046	01/26/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 28882	05/16/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Evaluation of Worker Notification Program Response Card	0920-0566	Attachment C Response Card

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ICR Summary of Burden

	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	8,000	0	0	8,000	0	0
Annual Time Burden (Hours)	1,333	0	0	1,333	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The only change to the ICR is the revised title, which better reflects the nature of the information collection. Although correct in the HHS system, Reginfo.gov reflects the long title as the current title.

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Annual Cost to Federal Government: $2,521

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/17/2012

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