Workplace Environment Changes and Safety Survey

Forms and Documents

Document Name	Status
SS-B - 0704-WECS - Workplace Survey 8.14.2020 Supporting Statement B	2020-08-14
0704-WECS_SS-A_8.14.2020.docx Supporting Statement A	2020-08-14
DoD CMO MEMO - Workplace Redefined Survey.pdf Supplementary Document	2020-08-10

IC Document Collections

IC ID	Document Title	Status
243088	Workplace Environment Changes and Safety Questionnaire Other-Survey	New

ICR Details

OMB Control No: 0704-0593	ICR Reference No: 202008-0704-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: DOD/DODDEP	Agency Tracking No: 0704-WECS
Title: Workplace Environment Changes and Safety Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/13/2020
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/15/2020
	Date Received in OIRA: 08/10/2020
Terms of Clearance: This collection is approved based on the revised materials provided by the Department for 6 months only. Should DOD wish to use this survey for longer than 6 months, the Department will need to publish a 60 and 30 day notice for this collection.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	6 Months From Approved
Responses	240	0	0
Time Burden (Hours)	20	0	0
Cost Burden (Dollars)	646	0	0

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Abstract: This survey is being used to provide leadership with an understanding of how effective newly implemented environment and safety policies are with making tenants feel safe for return to work at the Pentagon, Mark Center and DoD leased buildings and facilities in the National Capital region

Emergency Justfication: This survey requires emergency approval to quickly measure the effectiveness of newly implemented safety measures in preparation for employees to return to work.

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Authorizing Statute(s): None

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

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
Workplace Environment Changes and Safety Questionnaire

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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	240	0	0	240	0	0
Annual Time Burden (Hours)	20	0	0	20	0	0
Annual Cost Burden (Dollars)	646	0	0	646	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: There is no change to burden, this is a new collection.

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Annual Cost to Federal Government: $646

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? Yes

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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: 08/10/2020

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