Adult Occupational Injury--Line 9

National Health Interview Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0214 can be found here:

Documents and Forms

Document Name Document Type
Form 9 Adult Occupational Injury--Line 9 Form and Instruction
9 Chile Cancer--Line 8 NHIS 2010 Attachment 3h Occupational Injury.pdf Form and Instruction
Attachment4 Cover.doc Cover sheet for NIS Teen Questionnaire IC Document

Information Collection (IC) Details

IC Title:	Adult Occupational Injury--Line 9	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	9	Chile Cancer--Line 8	NHIS 2010 Attachment 3h Occupational Injury.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Health and Demographic Surveys Conducted in Probability Samples of the U.S. Population	FR Citation: 49 FR 37693

Number of Respondents: 25,000	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	Previously Approved
Annual Number of Responses for this IC	25,000	20,200	4,800
Annual IC Time Burden (Hours)	833	433	400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Cover sheet for NIS Teen Questionnaire	Attachment4 Cover.doc	08/07/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.