Information Collection

Second Injury Control and Risk Survey (ICARIS-2), Phase-2

IC 45314 under ICR 200609-0920-003 · OMB 0920-0513.

Documents and Forms

Document Name Document Type
Form none assigned Second Injury Control and Risk Survey (ICARIS-2), Phase-2 Form and Instruction
none assigned Second Injury Control and Risk Survey ICARIS-2 (Phase-2) Att#2-ICARIS2-Phase2-Survey-as-ofJuly2006.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Second Injury Control and Risk Survey (ICARIS-2), Phase-2	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 and Instruction	none assigned	Second Injury Control and Risk Survey ICARIS-2 (Phase-2)	Att#2-ICARIS2-Phase2-Survey-as-ofJuly2006.doc	none	No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	13	13
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.