Information Collection

Neiss

IC 207798 under ICR 202102-3041-001 · OMB 3041-0029.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3041-0029 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB0029-PC-NEISS-S NEISS	Form and Instruction
Form OMB0029-PC-NEISS-S PC-NEISS NEISS	Form and Instruction
OMB0029-PC-NEISS-S PC-NEISS OMB0029_2013_PCNEISS_Form.pdf	Form and Instruction
OMB0029-PC-NEISS-S PC-NEISS OMB0029_2013_PCNEISS_Form.pdf	Form and Instruction

IC Title:

NEISS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	OMB0029-PC-NEISS-Screenshots			NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 128

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	867,242	139,698	727,544
Annual IC Time Burden (Hours)	95,708	-5,073	100,781
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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