Neiss

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

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: 160	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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,084,053	216,811	867,242
Annual IC Time Burden (Hours)	130,000	34,292	95,708
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.