Information Collection

Pilot Survey To Test The Feasibility Of Collecting Behavioral/causal Data From Victims Treated In Hospital Emergency Rooms For Product-related Injuries Either 1) In

IC 149171 under ICR 198604-3041-002 · OMB 3041-0073.

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Information Collection (IC) Details

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IC Title:

PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,460

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,460	1,460
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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

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