Information Collection

Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey

IC 191021 under ICR 201208-0920-004 · OMB 0920-0834.

Documents and Forms

Document Name Document Type
Form 0920-0834 Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey Form and Instruction
0920-0834 EMS Worker Notification Form Attachment D_100428.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview 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	0920-0834	EMS Worker Notification Form	Attachment D_100428.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

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

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	-25	175
Annual IC Time Burden (Hours)	50	-8	58
Annual IC Cost Burden (Dollars)	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.