Information Collection

Childhood Injury and Adult Occupational Injury Survey

IC 36789 under ICR 200803-0535-002 · OMB 0535-0235.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0535-0235 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form QID 110916 Childhood Injury and Adult Occupational Injury Survey	Form and Instruction
Non_Response_Reply.doc	Other-Non-response statement
QID 110916 Childhood Injury and Adult Occupational Injury Questionn 2008 NIOSH CIAOI Questionnarie - Final.doc	Form and Instruction

IC Title:

Childhood Injury and Adult Occupational Injury Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form and Instruction	QID 110916	Childhood Injury and Adult Occupational Injury Questionnaire	2008 NIOSH CIAOI Questionnarie - Final.doc		No		Paper Only
Other-Non-response statement			Non_Response_Reply.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 120,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	120,400	-30,100	150,500
Annual IC Time Burden (Hours)	11,733	-378	12,111
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.