[NIOSH] Evaluation of Healthcare Worker Mental Health Campaign

Forms and Documents

Document Name	Status
Hospital Leader - Follow-Up Survey Form and Instruction	New
Healthcare Worker - Follow-Up Survey Form and Instruction	New
2b Responses to Federal Register Notice.docx Supplementary Document	2023-08-03
6 Invitation and Reminder Emails.docx Supplementary Document	2023-08-03
3 Non-Research Determination.pdf Supplementary Document	2023-08-03
2a Federal Register Notice.pdf Supplementary Document	2023-08-03
1b Dr. Lorna Breen Health Care Provider Protection Act.pdf Supplementary Document	2023-08-03
1a H.R.1319 American Rescue Plan Act of 2021.pdf Supplementary Document	2023-08-03
Supporting Statement B_NIOSH Health Worker MH Campaign_2.16.23.docx Supporting Statement B	2023-08-03
Supporting Statement A_NIOSH Health Worker MH Campaign_2.16.22.docx Supporting Statement A	2023-08-03

IC Document Collections

IC ID	Document Title	Status
261471	Hospital Leader - Follow-Up Survey Form and Instruction	New
261470	Healthcare Worker - Follow-Up Survey Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202308-0920-003
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22IU
Title: [NIOSH] Evaluation of Healthcare Worker Mental Health Campaign
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/08/2023

	Requested	Previously Approved
Expiration Date	12 Months From Approved
Responses	14,000	0
Time Burden (Hours)	2,333	0
Cost Burden (Dollars)	7,508	0

---

Abstract: Proposed study is designed to collect quantitative data to document outcomes of a social marketing campaign to improve the mental health and well-being of healthcare workers (e.g., mental health help seeking, modifications to working conditions, and healthcare worker well-being). Data generated through this information request will inform future campaign efforts that aim to reach healthcare workers and their employers and share findings to advance the health communications, mental health, and occupational health and safety fields. CDC requests OMB approval to collect information from 14,000 respondents for an estimated 2,333 burden hours, annually.

---

Authorizing Statute(s): PL: Pub.L. 117 - 2 1-11006 Name of Law: American Rescue Plan Act of 2021
   PL: Pub.L. 117 - 105 1-5 Name of Law: Dr. Lorna Breen Health Care Provider Protection Act
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 56593	09/16/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 24800	04/24/2023
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Healthcare Worker - Follow-Up Survey	NA	Healthcare Worker - Follow-Up Survey
Hospital Leader - Follow-Up Survey	NA	Hospital Leader - Follow-Up Survey

---

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	14,000	0	0	14,000	0	0
Annual Time Burden (Hours)	2,333	0	0	2,333	0	0
Annual Cost Burden (Dollars)	7,508	0	0	7,508	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: This is a New ICR submitted by NIOSH requesting approval for an estimated 2333 annual burden hours.

---

Annual Cost to Federal Government: $473,878

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  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:

(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: 08/08/2023

---