Information Collection

Reporting of Serious Injuries and Death

IC 219464 under ICR 202304-0970-001 · OMB 0970-0473.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument 1 - CCDF Consumer Education Website and Reports of Serious Injuries and Death Instructions Final 2023.docx	Instruction
Instrument 1 - CCDF Consumer Education Website and Reports of Serious Injuries and Death Instructions Final 2023.docx	Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 45 CFR 98

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
Instruction			Instrument 1 - CCDF Consumer Education Website and Reports of Serious Injuries and Death Instructions Final 2023.docx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	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.