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Federal forms, ICRs, and supporting documents

Information Collection Request

PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN

ICR 198604-3041-002 · OMB 3041-0073 · Historical Active

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IC IDCollectionTypeStatusForm
149171 PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN Migrated
ICR Details
3041-0073 198604-3041-002
Historical Active
CPSC
PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 05/29/1986
Retrieve Notice of Action (NOA) 04/07/1986
  Inventory as of this Action Requested Previously Approved
12/31/1986 12/31/1986
1,460 0 0
62 0 0
0 0 0
THIS SURVEY IS NEEDED TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL AND CAUSAL INFORMATION ABOUT PRODUCT-RELATED ACCIDENTS BY ANSWERING TWO QUESTIONS EITHER IN A HOSPITAL EMERGENCY DEPARTMENT OR O A POSTCARD AT HOME. THE INJURED PERSON OR SURROGATE WILL RESPOND.
None
None
No
  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 1,460 0 0 1,460 0 0
Annual Time Burden (Hours) 62 0 0 62 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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.
04/07/1986