Non Response Statement

Childhood Injury and Adult Occupational Injury Survey

Documents and Forms

Document Name Document Type
Non_Response_Reply.doc Other-Non Response Statement

Information Collection (IC) Details

IC Title:	Non Response Statement	Agency IC Tracking Number:

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
Other-Non Response Statement			Non_Response_Reply.doc		No		Paper Only

Line of Business: Economic Development

Subfunction: Industry Sector Income Stabilization

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,667	Number of Respondents for Small Entity: 5,337

Affected Public: Private Sector	Private Sector: Farms

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	13,334	3,300	10,034
Annual IC Time Burden (Hours)	444	38	406
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.