NORA AgFF OMB_Submission

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-0953)

TITLE OF INFORMATION COLLECTION: NORA Agriculture Forestry and Fishing Council Questionnaire

PURPOSE:

The Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH) seeks approval from the Office of Management and Budget (OMB) to collect information from a group of customers to determine preferences and priorities for future services and products. This data collection effort is focused on identifying future research priorities and communication products, which will be used in the initial development of the National Occupational Research Agenda (NORA) Agriculture Forestry and Fishing Research Agenda.

NORA is a partnership program established to stimulate innovative research and improved workplace safety and health practices. Unveiled in 1996, NORA has become a research framework for the nation (not just NIOSH). Diverse parties collaborate to identify the most critical issues in workplace safety and health. Partners then work together to develop goals and objectives for addressing these needs. NIOSH and its partners have formed NORA councils, including stakeholders from academia, industry, labor, and government. Each council is charged with developing sector-specific safety and health research priorities for the nation. These priorities provide guidance to the entire occupational safety and health community for moving research to practice in workplaces.

To ensure that NORA Agriculture Forestry and Fishing Research Agenda will satisfy our customers’ needs and result in improved services and products, NIOSH proposes to utilize a brief on-line questionnaire to collect information on which occupational safety and health issues are most critical for future collaboration based on their experiences and preferences. Completion of the questionnaire is strictly voluntary and the limited number of questions and time required to complete the questionnaire will result in a low burden to the participants. The questionnaire will not collect personally identifiable information. Results from the questionnaire will be used to facilitate a discussion with the same group of customers to further refine those priorities, resulting in distinct research priorities for the NORA Agriculture Forestry and Fishing Research community. The results will not be disseminated publically or be used for program evaluation.

DESCRIPTION OF RESPONDENTS:

Respondents will include current members of the NORA Agriculture Forestry and Fishing Council. The council membership reflects that diversity of companies, associations, and other agencies with an interest in worker safety and health in the Agriculture Forestry and Fishing industry. In total, this group is comprised of approximately 80 individuals representing industry, government, academia, and labor.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[] Focus Group [X] Other: Online Customer Questionnaire

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Noemi Avalos

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	No. of Responses per Respondent	Avg. Burden per Response (in hours)	Total Burden Hours
NORA Agriculture Forestry and Fishing Council Members	80	1	30/60	40
Totals				40

FEDERAL COST: The estimated annual cost to the Federal government is $200 (personnel time)

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [] Yes [X ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Participation will be completely voluntary and respondents will receive no monetary incentive for participation. All the current members of the NORA Agriculture Forestry and Fishing Council will be invited to complete the questionnaire. Information about the council and meetings are posted on the NIOSH website, ensuring all interested parties have the opportunity to opt into these meetings.

Data collection:

1. An introductory email and link to the questionnaire will be sent to each participant (Appendix 1).

2. The questionnaire (Appendix 2—Separate attachment) will take up to 30 minutes to complete.

3. Results will be automatically saved so that respondents will not need to return their responses to NIOSH, thus ensuring confidentiality and low burden.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households;(2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected.

No. of Respondents: Provide an estimate of the Number of respondents.

Participation Time: Provide an estimate of the amount of time required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of responses and the participation time and divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Appendix 1. Draft introductory text that will be sent to 80 respondents via email:

Dear NORA Agriculture Forestry and Fishing Council Members,

As we begin our third decade of NORA, we would like your thoughts and ideas about which occupational safety and health issues are most critical for worker and workplace safety and health research in the Agriculture Forestry and Fishing sector, based on your experiences. Included in this email is a link to a brief online questionnaire for you to provide us input. Your participation is voluntary, and I expect that it will take you no longer than 30 minutes to complete. The questionnaire does not collect personally identifiable information and the results will not be disseminated publically. Results from the questionnaire will be used to facilitate a discussion during our next NORA Agriculture Forestry and Fishing Council meeting, and as the basis for developing a new NORA Agriculture Forestry and Fishing Research Agenda.

I hope you will take a few minutes to help shape the next decade of Agriculture, Forestry and Fishing safety and health research through NORA. Thank you very much for your time. If you have any questions about this questionnaire or the NORA Agriculture Forestry and Fishing Council meeting, please contact me.

Sincerely,

Brad Husberg

CAPT, US Public Health Service

Director, Office of Agriculture Safety and Health

Manager, Agriculture, Forestry, and Fishing Program

National Institute for Occupational Safety and Health

Centers for Disease Control and Prevention

4230 University Drive, #310

Anchorage, AK  99508

907-271-5259

bjh9@cdc.gov

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