Information Collection

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

IC 191021 under ICR 201208-0920-004 · OMB 0920-0834.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-0834 EMS Worker Notification Form Occupational injuries and illnesses among emergency medical services (EMS) workers: A NEISS-Work telephone interview survey	Form and Instruction
0920-0834 EMS Worker Notification Form Attachment D_100428.doc	Form and Instruction

IC Title:

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	0920-0834				Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Epidemiologic Studies and Surveillance of Disease Problems

FR Citation: 57 FR 62812

Number of Respondents: 150

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	150	-25	175
Annual IC Time Burden (Hours)	50	-8	58
Annual IC Cost Burden (Dollars)	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.

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