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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Occupational Injuries and Illness Code Selection Study
Agency IC Tracking Number:
22404
IC Status:
New
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
Instruction
Appendix A Scenario Materials.docx
Yes
No
Printable Only
Form and Instruction
Appendix B
Cognitive Interview Protocol
Appendix B Interview Protocol.docx
Yes
No
Printable Only
Form
Appendix D
Screening Questions
Appendix D Screening questions.docx
Yes
No
Printable Only
Form and Instruction
Appendix E
Informed Consent
Appendix E Informed Consent.docx
Yes
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Records & Statistical Mgt
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
60
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
60
0
60
0
0
0
Annual IC Time Burden (Hours)
25
0
25
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Appendix C
Appendix C Recruitment advertisements.docx
02/02/2024
Note to Reviewer - Occupational Injuries and Illness Code Selection Study
Note to Reviewer - Occupational Injuries and Illnesses Code Selection Study.docx
02/02/2024
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.