Information Collection

National Accident Sampling System Interview Form Accident And Injury Factors

IC 142060 under ICR 197912-2127-001 · OMB 2127-0021.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2127-0021 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	NATIONAL ACCIDENT SAMPLING SYSTEM INTERVIEW FORM ACCIDENT AND INJURY FACTORS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	(4/78)	No	No
Form	HS-428	No	No
Form	HS-429	No	No
Form	HS-433	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	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	12,000	3,000	9,000
Annual IC Time Burden (Hours)	4,000	1,000	3,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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