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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[2022, NIOSH] Formative Research and Field Pilot Evaluation to Inform the Development of a NIOSH Training Product, the Safety Skills at Work Curriculum
Agency IC Tracking Number:
0920-1154-21GU
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
None
Safety Skills at Work Pre-Survey
Attachment D- Pre-Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Safety Skills at Work Post-Survey
Attachment E- Post-Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Safety Skills at Work Follow-up Survey
Attachment F- Follow-up Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
None
Safety Skills at Work Post-Training Feedback Session Questions
Attachment G- Post-Training Feedback Session Questions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Worker Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
72
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
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
72
0
72
0
0
0
Annual IC Time Burden (Hours)
84
0
84
0
0
0
Annual IC Cost Burden (Dollars)
2,178
0
2,178
0
0
0
Documents for IC
Title
Document
Date Uploaded
Supporting Statement Part A
Supporting Statement A_07-19-22.docx
07/19/2022
Supporting Statement Part B
Supporting Statement B_07-18-22.docx
07/19/2022
Authorizing Legislation: Occupational Safety and Health Act
Attachment A- OSH Act.docx
07/19/2022
Safety Skills at Work: Main Curriculum Document (draft)
Attachment B- Draft Main Curriculum Document.docx
07/19/2022
Safety Skills at Work: PowerPoint Presentation (draft)
Attachment C- Draft PowerPoint Slides.pptx
07/19/2022
CDC Determination: IRB Approval is Not Required
Attachment H- IRB Nonresearch Determination.pdf
07/19/2022
Recruitment Script
Attachment I- Recruitment Script.docx
07/19/2022
Consent Script
Attachment J- Consent Script.docx
07/19/2022
Emails to Confirm Participation Details
Attachment K- Emails to Confirm Pilot Details.docx
07/19/2022
Survey Administration Emails
Attachment L- Survey Admininistration Emails.docx
07/19/2022
Survey Reminder Emails
Attachment M- Survey Reminder Emails.docx
07/19/2022
Flowchart of Steps for Each Cohort
Attachment N- Flowchart of Steps for Each Cohort.docx
07/19/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.