Childhood Injury and Adult Occupational Injury Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form QID Childhood Injury and Adult Occupational Injury Questionnaire	Form and Instruction	Modified	Available
Form QID All - Terrain Vehicle Prevlance and Injury Questionnaire	Form and Instruction	Modified	Available
0235-niosh-11-SSA.docx	Supporting Statement A	Uploaded 2011-11-28	Available
Racial Minority Youth 2007-163.pdf	Supplementary Document	Uploaded 2011-11-08	Available
Hispanic Youth 2007-162.pdf	Supplementary Document	Uploaded 2011-11-08	Available
Farm Youth 2007-161.pdf	Supplementary Document	Uploaded 2011-11-08	Available
Presurvey_Letter_2009 Survey jrm.doc	Supplementary Document	Uploaded 2011-11-08	Available
NASDA-004_revised_mar2007.pdf	Supplementary Document	Uploaded 2011-11-08	Available
0235 - NIOSH Bibliography of Publications - Oct 2011.doc	Supplementary Document	Uploaded 2011-11-08	Available
0235 - Youth Injuries on Minority Farms - 2008.pdf	Supplementary Document	Uploaded 2011-11-08	Available
0235 - Farm and Ranch Safety Survey - 2006.pdf	Supplementary Document	Uploaded 2011-11-08	Available
0235 - Injuries to Hispanic Operators - 2008.pdf	Supplementary Document	Uploaded 2011-11-08	Available
PIA - NASS UNIX MA Oct. 2011.doc	Supplementary Document	Uploaded 2011-11-08	Available
0235-niosh-11-SSB.doc	Supporting Statement B	Uploaded 2011-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
36789	Childhood Injury and Adult Occupational Injury Survey	Form and Instruction	Modified	Childhood Injury and Adult Occupational Injury Questionnaire
36789	Childhood Injury and Adult Occupational Injury Survey	Form and Instruction	Modified	All - Terrain Vehicle Prevlance and Injury Questionnaire
184429	Non Response Statement	Other-Non Response Statement	Modified

ICR Details

OMB Control No: 0535-0235	ICR Reference No: 201110-0535-001
Status: Historical Inactive	Previous ICR Reference No: 200803-0535-002
Agency/Subagency: USDA/NASS	Agency Tracking No:
Title: Childhood Injury and Adult Occupational Injury Survey
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/14/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/06/2011
Terms of Clearance: Withdrawn at agency request 2/14/2012 due to anticipated redesign of collection.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved	02/29/2012
Responses	0	0	150,500
Time Burden (Hours)	0	0	12,404
Cost Burden (Dollars)	0	0	0

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

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Authorizing Statute(s): US Code: 7 USC Sec. 2204 (a) 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
   PL: Pub.L. 107 - 347 503(a) Name of Law: CIPSEA
   PL: Pub.L. 91 - 596 20 Name of Law: Occupational Safety and Health Act
   PL: Pub.L. 91 - 173 501 Name of Law: Federal Mine Safety and Health Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 146	07/29/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 75519	12/02/2011
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Childhood Injury and Adult Occupational Injury Survey	QID, QID	All - Terrain Vehicle Prevlance and Injury Questionnaire ,   Childhood Injury and Adult Occupational Injury Questionnaire
Non Response Statement

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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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden and respondent reduction is caused by miscellaneous actions. The survey will only be conducted two times during the three year approval instead of it being done annually. The majority of the reduction in the number of respondents is due to a correction in an error made during the previous submission. There is a slight increase in burden hours due to results from the previous data collection. The questionnaire burden was changed from 10 minutes to 12 minutes to complete.

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Annual Cost to Federal Government: $700,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 12/06/2011

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