Information Collection

Underreporting of Occupational Injuries and Illness by Workers

IC 201269 under ICR 201202-0920-005 · OMB 0920-0938.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Underreporting of Occupational Injuries and Illness by Workers	Form
1 NIOSH Congressional Under-Reporting Questionnaire App F Injuries 2012_01_26.docx	Form
2 NIOSH Congressional Under-Reporting Questionnaire--Spani App G Congressional Questionnaire Spanish 2012_01_26.docx	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	1	NIOSH Congressional Under-Reporting Questionnaire	App F Injuries 2012_01_26.docx		Yes	No	Paper Only
Form	2	NIOSH Congressional Under-Reporting Questionnaire--Spanish Version	App G Congressional Questionnaire Spanish 2012_01_26.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	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.