Information Collection

Underreporting of Occupational Injuries and Illness by Workers

IC 201269 under ICR 201202-0920-005 · OMB 0920-0938.

Documents and Forms

Document Name Document Type
Form 1 Underreporting of Occupational Injuries and Illness by Workers Form
1 NIOSH Congressional Under-Reporting Questionnaire App F Injuries 2012_01_26.docx Form
2 NIOSH Congressional Under-Reporting Questionnaire--Spani App G Congressional Questionnaire Spanish 2012_01_26.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Underreporting of Occupational Injuries and Illness 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	1	NIOSH Congressional Under-Reporting Questionnaire	App F Injuries 2012_01_26.docx		Yes	No	Paper Only
Form	2	NIOSH Congressional Under-Reporting Questionnaire--Spanish Version	App G Congressional Questionnaire Spanish 2012_01_26.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

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

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,500	1,500
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.