View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1218-0280
ICR Reference No:
202501-1218-004
Status:
Active
Previous ICR Reference No:
202202-1218-002
Agency/Subagency:
DOL/OSHA
Agency Tracking No:
1218-0280
Title:
Pilot Study and Prospective Analysis of the Draft Revised Form 33, Safety and Health Program Assessment Worksheet
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/27/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/14/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2028
36 Months From Approved
06/30/2025
Responses
810
0
2,139
Time Burden (Hours)
888
0
4,974
Cost Burden (Dollars)
0
0
0
Abstract:
OSHA conducts validity and reliability analyses of a safety and health program assessment worksheet, the Draft Revised Form 33. The studies will enable OSHA to ensure that a valid, reliable, and efficient tool is provided to On-Site Consultation programs in the fifty states, the District of Columbia, and several United States territories to replace the current OSHA Form 33, thereby, enhancing the quality of consultative services. The studies for which OSHA has requested approval comprises of a pre-test, a follow-up study, and a Prospective Analysis and OSHA is requesting additional time to complete the remaining studies. After completing the Pilot Study, OSHA will request OMB approval before implementing the DRF33 for use by state On-Site Consultation programs nationwide (to replace the current Form 33). Similarly, OSHA will seek OMB approval if any additional updates are made to the approved worksheet, following the Prospective Analysis.
Authorizing Statute(s):
US Code:
29 USC 651
Name of Law: Occupational Safety and Health Act
US Code:
29 USC 670
Name of Law: Occupational Safety and Health 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:
90 FR 2756
01/13/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 20511
05/14/2025
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for Pilot Study
Form 33
On Site Consultation Progam Safety and Health Assessment Worksheet (OSHA Form 33)
Estimated Respondent (State Consultation Programs) Hour and Cost Burden for the Prospective Analysis
Summary of Estimated Respondent (Employer) Hour and Cost Burden
ICR Summary of Burden
Total Approved
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
810
2,139
0
0
-1,329
0
Annual Time Burden (Hours)
888
4,974
0
0
-4,086
0
Annual Cost Burden (Dollars)
0
0
0
0
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:
No
Burden Reduction Due to:
Short Statement:
The agency is retaining a balance of 888 burden hours to complete the remaining tasks for the pilot study from 4,974 burden hours originally estimated to complete the entire pilot study.
Annual Cost to Federal Government:
$41,375
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
Agency Contact:
Peter Andrews 202 693-2264 andrews.peter@dol.gov
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:
05/14/2025
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