Information Collection

Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey

IC 191021 under ICR 200910-0920-005 · OMB 0920-0834.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0834 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey Form and Instruction
1 EMS Worker Injury and Illness Questionnaire Appendix D_090910.doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey	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	1	EMS Worker Injury and Illness Questionnaire	Appendix D_090910.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 175	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	58	58
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.