Information Collection

Childhood Injury and Adult Occupational Injury Survey

IC 36789 under ICR 201110-0535-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Childhood Injury and Adult Occupational Injury Survey	Form and Instruction
QID All - Terrain Vehicle Prevlance and Injury Questionnaire 0235 - ATV 2012 Questionnaire.docx	Form and Instruction
QID Childhood Injury and Adult Occupational Injury Questionn 0235 - 2008 NIOSH CIAOI Questionnarie.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	All - Terrain Vehicle Prevlance and Injury Questionnaire	0235 - ATV 2012 Questionnaire.docx		No		Paper Only
Form and Instruction	QID	Childhood Injury and Adult Occupational Injury Questionnaire	0235 - 2008 NIOSH CIAOI Questionnarie.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records

Title: SORN

FR Citation: 74 FR 79

Number of Respondents: 20,000

Number of Respondents for Small Entity: 17,000

Affected Public: Private Sector

Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20,000	-20,400	-80,000	120,400
Annual IC Time Burden (Hours)	7,334	-5,066	667	11,733
Annual IC Cost Burden (Dollars)	0	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.