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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
[NIOSH] Virtual Focus Groups to Obtain Feedback from Retail Employers and Employees on WMSDs and STFs
Agency IC Tracking Number:
0920-0953-23BM
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
Screening Tool for Recruitment: Employers
Appendix B_Screener for employers.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Screener and Demographic Questionnaire: Workers
Appendix C_Screener for workers.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Employee Focus Groups Older Workers
Appendix D_Focus Group guide for older retail workers.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Employee Focus Groups Younger Workers
Appendix E_Focus group guide for younger retail workers.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
None
Employers Focus Group
Appendix F_ Focus group guide for Retail Employers.pdf
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:
48
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Not-for-profit institutions, 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
48
0
48
0
0
0
Annual IC Time Burden (Hours)
76
0
76
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GENIC Template with Project Description: Focus Groups on WMSDs and STFs
Fast Track_ Gen IC_Retail project_12.2.22.docx
12/02/2022
Verbal Consent
Appendix A_Verbal Consent.pdf
12/02/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.