Pilot Survey To Test The Feasibility Of Collecting Behavioral/causal Data From Victims Treated In Hospital Emergency Rooms For Product-related Injuries Either 1) In

PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN

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Information Collection (IC) Details

IC Title:	PILOT SURVEY TO TEST THE FEASIBILITY OF COLLECTING BEHAVIORAL/CAUSAL DATA FROM VICTIMS TREATED IN HOSPITAL EMERGENCY ROOMS FOR PRODUCT-RELATED INJURIES EITHER 1) IN	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,460	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
Annual Number of Responses for this IC	1,460	1,460
Annual IC Time Burden (Hours)	62	62
Annual IC Cost Burden (Dollars)	0	0

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.