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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Farm to Table: Knowledge Base Preventing Musculoskeletal Disorders Among Food and Beverage Workers
Agency IC Tracking Number:
0920-22BO
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
n/a
Focus Group Guide (script) for Stakeholders
Attachment C - Focus Group Guide for Stakeholders - Farm to Table.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
Focus Group Guide (script) for Workers
Attachment D - Focus Group Guide for Workers - Farm to Table.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
126
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Farms, Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
126
0
126
0
0
0
Annual IC Time Burden (Hours)
189
0
189
0
0
0
Annual IC Cost Burden (Dollars)
5,198
0
5,198
0
0
0
Documents for IC
Title
Document
Date Uploaded
GENIC Template with Brief Project Description (Farm to Table)
GENIC Template_Farm to Table.docx
01/20/2022
Supporting Statement Part A
Supporting Statement A_01.18.22.docx
01/20/2022
Supporting Statement Part B
Supporting Statement B_01.18.2022.docx
01/20/2022
Occupational Safety and Health Act of 1970
Attachment A. OSH Act of 1970.pdf
01/20/2022
Recruitment and Consent Scripts
Attachment B - Recruitment Consent Form_01.18.2022.docx
01/20/2022
CDC Determination: IRB Approval is Not Required
Attachment E - Nonresearch Determination_Farm to Table.pdf
01/20/2022
List of Companies Eligible for Participation
Attachment F - Sampling and Eligible List - Farm to Table.docx
01/20/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.