Information Collection

Household Survey of Injuries and Illnesses

IC 220841 under ICR 201706-1220-008 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment A Household Survey of Injuries and Illnesses	Form and Instruction
Attachment A Interview Protocol Attachment 4 Interview Protocol.docx	Form and Instruction
Note to Reviewer - HSOII Cognitive Testing.docx Note to Reviewer - Household Survey of Injuries and Illnesses	IC Document

IC Title:

Household Survey of Injuries and Illnesses

Agency IC Tracking Number:

21612

IC Status: Unchanged

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	Attachment A	Interview Protocol	Attachment 4 Interview Protocol.docx		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	165	165
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - Household Survey of Injuries and Illnesses	Note to Reviewer - HSOII Cognitive Testing.docx	03/31/2016

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