Information Collection

1-Enhanced Component -Injury Indicator

IC 220446 under ICR 201603-0920-003 · OMB 0920-1120.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att E_Injury Indicators.010716.xlsx	Other-WORD
Att E2_Inj Ind Instructions.pdf E2_Injury Indicator Spreadsheet Instructions	IC Document

IC Title:

Agency IC Tracking Number:

16BK

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
Other-WORD			Att E_Injury Indicators.010716.xlsx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5	5
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
E2_Injury Indicator Spreadsheet Instructions	Att E2_Inj Ind Instructions.pdf	03/03/2016

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