Information Collection

Childhood Injury and Adult Occupational Injury Survey

IC 36789 under ICR 201205-0535-001 · OMB 0535-0235.

Documents and Forms

Document Name Document Type
Form QID Childhood Injury and Adult Occupational Injury Survey Form and Instruction
QID Childhhood Injury and Adult Occupational Injury Question 0235 - 2012 NIOSH CAIS questionnaire.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Childhood Injury and Adult Occupational Injury 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 and Instruction	QID	Childhhood Injury and Adult Occupational Injury Questionnnaire	0235 - 2012 NIOSH CAIS questionnaire.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26,667	Number of Respondents for Small Entity: 21,300

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	53,334	13,201	-110,367	150,500
Annual IC Time Burden (Hours)	8,889	-2,816	-406	12,111
Annual IC Cost Burden (Dollars)	0	0	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.