Childhood Injury and Adult Occupational Injury Suvey

Forms and Documents

Document Name	Status
Form QID 110916 Childhood Injury and Adult Occupational Injury Survey Form and Instruction	Modified
0235-niosh-08-responses to OMB questions.doc Supplementary Document	2008-12-17
0235-niosh-08-SSA.doc Supporting Statement A	2008-05-07
0235-niosh-08-SSB.doc Supporting Statement B	2008-04-10
Title 18 USC - Sec 1905 - Disclosure.doc Supplementary Document	2008-04-10
Title 7USC - Sec 2276-Confidentiality[1].doc Supplementary Document	2008-04-10
Title 7USC - Sec. 2204 Gen Duties[1].doc Supplementary Document	2008-04-10
Racial Minority Youth 2007-163.pdf Supplementary Document	2008-04-07
Hispanic Youth 2007-162.pdf Supplementary Document	2008-04-07
Farm Youth 2007-161.pdf Supplementary Document	2008-04-07
Presurvey_Letter_2009 Survey jrm.doc Supplementary Document	2008-04-07
0235 - Childhood Injury-Dec-2002.pdf Supplementary Document	2008-04-07
0235 - Childhood Injury-01-08-2004.pdf Supplementary Document	2008-04-07
NIOSH-USDA Publications.doc Supplementary Document	2008-04-07
Privacy-Impact-Assessment[1].doc Supplementary Document	2008-04-07

IC Document Collections

IC ID	Document Title	Status
36789	Childhood Injury and Adult Occupational Injury Survey Form and Instruction	Modified
184429	Non Response Statement Other-Non Response Statement	New

ICR Details

OMB Control No: 0535-0235	ICR Reference No: 200803-0535-002
Status: Historical Active	Previous ICR Reference No: 200602-0535-004
Agency/Subagency: USDA/NASS	Agency Tracking No:
Title: Childhood Injury and Adult Occupational Injury Suvey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/18/2008
	Date Received in OIRA: 05/15/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	12/31/2008
Responses	150,500	0	150,500
Time Burden (Hours)	12,404	0	12,111
Cost Burden (Dollars)	0	0	0

---

Abstract: Measure incidence of nonfatal injuries occuring to children on farms and agricultural injury to adults.

---

Authorizing Statute(s): US Code: 7 USC Sec. 2204 Name of Law: General Duties of Secretary
   US Code: 7 USC Sec. 2276 Name of Law: Confidentiality of Information
   US Code: 18 USC Sec. 1905 Name of Law: Disclosure of Confidential Information Generally
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 31	02/14/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 91	05/09/2008
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Childhood Injury and Adult Occupational Injury Survey	QID 110916	Childhood Injury and Adult Occupational Injury Questionnaire
Non Response Statement

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	150,500	150,500	0	0	0	0
Annual Time Burden (Hours)	12,404	12,111	0	0	293	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is an adjustment increase of 293 burden hours.

---

Annual Cost to Federal Government: $250,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/15/2008

---