Nurse Survey

Workplace Violence Prevention Programs In New Jersey Healthcare Facilities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0914 can be found here:

Documents and Forms

Document Name Document Type
Nurse Survey Form
Nurse Survey Nurse Survey clean 6.5.2012.doc Form
Final LetterChanges 6 11 2012.docx Final Letter IC Document
Introduction Letter Clean 6 6 2012.docx Introduction Letter IC Document
Reminder Letter Changes 6 11 2012 (6).docx Reminder Letter IC Document

Information Collection (IC) Details

IC Title:	Nurse Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Nurse Survey	Nurse Survey clean 6.5.2012.doc		Yes	No	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Final Letter	Final LetterChanges 6 11 2012.docx	06/12/2012
Introduction Letter	Introduction Letter Clean 6 6 2012.docx	06/12/2012
Reminder Letter	Reminder Letter Changes 6 11 2012 (6).docx	06/12/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.