Workplace Environment Changes and Safety Survey

ICR 202008-0704-001

OMB: 0704-0593

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement B
2020-08-14
Supporting Statement A
2020-08-14
Supplementary Document
2020-08-10
IC Document Collections
ICR Details
0704-0593 202008-0704-001
Active
DOD/DODDEP 0704-WECS
Workplace Environment Changes and Safety Survey
New collection (Request for a new OMB Control Number)   No
Emergency 08/13/2020
Approved with change 08/15/2020
Retrieve Notice of Action (NOA) 08/10/2020
This collection is approved based on the revised materials provided by the Department for 6 months only. Should DOD wish to use this survey for longer than 6 months, the Department will need to publish a 60 and 30 day notice for this collection.
  Inventory as of this Action Requested Previously Approved
02/28/2021 6 Months From Approved
240 0 0
20 0 0
646 0 0

This survey is being used to provide leadership with an understanding of how effective newly implemented environment and safety policies are with making tenants feel safe for return to work at the Pentagon, Mark Center and DoD leased buildings and facilities in the National Capital region
This survey requires emergency approval to quickly measure the effectiveness of newly implemented safety measures in preparation for employees to return to work.

None
None

Not associated with rulemaking

No

1
IC Title Form No. Form Name
Workplace Environment Changes and Safety Questionnaire

  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 240 0 0 240 0 0
Annual Time Burden (Hours) 20 0 0 20 0 0
Annual Cost Burden (Dollars) 646 0 0 646 0 0
Yes
Miscellaneous Actions
No
There is no change to burden, this is a new collection.

$646
Yes Part B of Supporting Statement
    No
    No
No
No
No
Yes
Lane Purvis 571 372-0459 lane.m.purvis2.civ@mail.mil

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/10/2020


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