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

Forms and Documents

Document Name	Status
Form 0920-1244 Fire Fighters Follow-back Survey Form and Instruction	Modified
Attachment G PIA_National Electronic Injury Surveillance System (NEISS).pdf Supplementary Document	2021-09-29
Attachment F- IRB.pdf Supplementary Document	2021-09-29
Attachment E_protocol.docx Supplementary Document	2021-09-29
Attachment D FF Pre_Interview_Consent_Letter.docx Supplementary Document	2021-09-29
Attachment A_OSH Act.docx Supplementary Document	2021-09-29
Attachment B FF 60-day FRN.pdf Supplementary Document	2021-09-29
FF_ICR_SupportingStatement_B Sept_2021_final.docx Supporting Statement B	2021-09-29
FF_ICR_SupportingStatement_A Sept_2021_final.docx Supporting Statement A	2021-09-29

IC Document Collections

IC ID	Document Title	Status
231809	Fire Fighters Follow-back Survey Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1244	ICR Reference No: 202109-0920-012
Status: Received in OIRA	Previous ICR Reference No: 201806-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1244
Title: Assessment of Occupational Injury among Fire Fighters Using a Follow-back Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/13/2021

	Requested	Previously Approved
Expiration Date	12 Months From Approved	10/31/2021
Responses	35	240
Time Burden (Hours)	18	120
Cost Burden (Dollars)	454	2,915

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Abstract: 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.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 20 Name of Law: OSH 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:
	86 FR 38100	07/19/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 56958	10/13/2021
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
Fire Fighters Follow-back Survey	0920-1244	Fire Fighter Follow-back Survey revised

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ICR Summary of Burden

	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

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The decrease is due to the request to extend the collection one more year to collect info from a small number of respondents.

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Annual Cost to Federal Government: $66,804

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? No

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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: 10/13/2021

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