Neiss

National Electronic Injury Surveillance System (NEISS) and Follow-up Activities for Product Related Injuries

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form OMB0029-PC-NEISS-S 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

Information Collection (IC) Details

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	OMB0029-PC-NEISS-Screenshots	PC-NEISS	OMB0029_2013_PCNEISS_Form.pdf	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 %

	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

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.