Request for Approval

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

T ITLE OF INFORMATION COLLECTION: Survey to solicit feedback on technical assistance on worker safety and health provided as part of the COVID-19 response

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. NIOSH would like to conduct a follow-up survey on the field and virtual technical assistance (TA) provided by the Worker Safety and Health team during the COVID-19 response. These engagements are typically done at the request of state, local and tribal health departments and include one or more employers. Recipients either receive a field visit from CDC/NIOSH staff (“field” technical assistance) or remote assistance from CDC/NIOSH staff working at their normal duty station (“virtual” technical assistance). In both field and virtual TA, CDC/NIOSH staff provide recommendations on ways to prevent the spread of COVID-19 in the workplace.

The survey will help NIOSH assess satisfaction of TA recipients, and better understand the facilitators and barriers to implementing recommendations. There are two slightly different versions of the survey, one for virtual TA recipients and one for field TA recipients. The information will be used to improve TA in the COVID-19 response and future responses.

DESCRIPTION OF RESPONDENTS:

Respondents are recipients of field and virtual TA from the WSH team. For each TA engagement, the main state, local, or tribal health department contact; employer contact; and union/worker organization contact (if applicable) will each be invited via email to take the survey.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [ ] Other: ______________________

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: Emily Novicki

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

3. If Yes, has an up-to-date System of Records Notice (SORN) 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

Type of Respondent	Form Name	No. of Respondents	Average Burden per Response (in hours)	Total Burden Hours
Private Sector	Field survey	640	12/60	128 hours
	Virtual survey	160	12/60	32 hours
State, local, or tribal governments	Field survey	320	12/60	64 hours
	Virtual survey	80	12/60	16 hours
Total 240 hours

FEDERAL COST: The estimated annual cost to the Federal government is $7500 (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? [x] Yes [ ] 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?

The Worker Safety and Health team has provided a range of field and virtual TA, from responding to a single specific question to multi-day engagements. In order to create a sample with similar characteristics, inclusion and exclusion criteria were developed. This data collection is intended to focus on the industrial hygiene component of the field and virtual TA rather than epidemiology, as industrial hygiene is a unique contribution by the Worker Safety and Health team to the overall CDC response. We estimate 400 engagements will be included in the sample by the time the survey concludes in in September 2021.

Inclusion criteria	Rationale
TA concluded at least two months ago	Allows sufficient time for implementation
NIOSH provided or contributed to site-specific recommendations (e.g., memo, verbal recommendations)	Ensure a minimum level of engagement and communication between NIOSH and requestor
One or more NIOSH staff participated in TA to provide industrial hygiene TA	Want to include instances where NIOSH was embedded in larger CDC teams
Industrial hygiene TA was provided in workplaces where NIOSH was the main author of the guidance (e.g., food processing)	Evaluating TA, not guidance
Industrial hygiene TA was provided in workplaces where NIOSH was not the main author of the guidance (e.g., detention centers)	Evaluating TA, not guidance
Review of employer reopening or operating plans	WSH team provided detailed comments to requestors, making this a form of virtual TA

Exclusion criteria	Rationale
Webinars and other one-time speaking engagements	Ensure a minimum level of engagement and communication between NIOSH and requestee. Speaking engagements provide high-level overviews of guidance, rather than site-specific TA
Responses to one-off questions	Ensure a minimum level of engagement and communication between NIOSH and requestee
Field visits/virtual engagements where NIOSH’s only role was to provide epidemiology support	These surveys will only focus on industrial hygiene TA provided, rather than epidemiology
State, local, or tribal health department recommends against inclusion because employer has already indicated they do not want further contact	We want to be sensitive to the burden that a survey places on employers and respect the wishes of those who have indicated that they do not wish to have further contact.

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. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

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 per row.

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.

Submit all instruments, instructions, and scripts are submitted with the request.

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