Information Collection

Barriers to occupational injury reporting by workers

IC 200876 under ICR 201201-0920-008 · OMB 0920-0939.

Documents and Forms

Document Name Document Type
Barriers to occupational injury reporting by workers Form
Appendix D Barriers to Reporting Questionnaire AppD Barriers to Reporting Questionnaire_120502.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Barriers to occupational injury reporting by workers	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	Appendix D Barriers to Reporting Questionnaire	AppD Barriers to Reporting Questionnaire_120502.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	600	600
Annual IC Time Burden (Hours)	300	300
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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