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

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

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 Att 2 - Data collection Instrument for ICARIS-2 (Phase-2 Att#2-ICARIS2-Phase2-Survey-as-ofJuly2006.doc Form and Instruction

Information Collection (IC) Details

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

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	-8,000	8,500
Annual IC Time Burden (Hours)	8	-5,889	5,897
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.