Fire Fighters Follow-back Survey

Assessment of Occupational Injury among Fire Fighters Using a Follow-back Survey

Documents and Forms

Document Name Document Type
Form 0920-1244 Fire Fighters Follow-back Survey Form and Instruction
0920-1244 Fire Fighter Follow-back Survey revised Attachment C Firefighter_Survey.docx Form and Instruction
0920-1244 Fire Fighter Follow-back Survey revised Attachment C Firefighter_Survey.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Fire Fighters Follow-back Survey	Agency IC Tracking Number:	0920-1244

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	0920-1244	Fire Fighter Follow-back Survey revised	Attachment C Firefighter_Survey.docx	NA	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Epidemiologic Studies and Surveillance of Disease Problems	FR Citation: 57 FR 62812

Number of Respondents: 35	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	-205	240
Annual IC Time Burden (Hours)	18	-102	120
Annual IC Cost Burden (Dollars)	454	-2,461	2,915

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.