SUPPLEMENTARY DATA SYSTEM

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
123754	SUPPLEMENTARY DATA SYSTEM	Migrated

ICR Details

OMB Control No: 1220-0083	ICR Reference No: 198403-1220-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: SUPPLEMENTARY DATA SYSTEM
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/1984
	Date Received in OIRA: 03/12/1984
Terms of Clearance: This request for clearance of the supplementary data system is approve for a single collection of data. While this approval continues through September 1985, this clearance terminates after a single collection of information from each participating State has been accomplished or on September 30, l985, whichever occurs first. No State may be asked to provide data under this clearance after the State has once provided a data set or after September 30, l985. OMB will consider extending this clearance and approving of additional collections of information for the supplementary data system upon a showing by the Department that the data show statistically significant differences over time after the data have been standardize to eliminate the effects of interindustry shifts in employment and standardized data have been compared for identical States across each set of data collections conducted from 1976 through the data collectio hereby approved. Any request for extension or revision of this approval must be accompanied by the analysis described above. In addition to the three copies of the clearance package usually submitted, DOL is to provide an additional two (2) sets of any package requesting extension or revision of this approval. Each package is to contain a full set of th analysis described above. The data are to be presented in aggregate fo all States consistently included in the collection and for each State.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1985	09/30/1985
Responses	30	0	0
Time Burden (Hours)	324,600	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: PROVIDES DETAILED INFORMATION ON CHARACTERISTICS OF WORK-RELATED INJURIES AND ILLNESSES AND THE ACCIDENTS OR EXPOSURES WHICH PRODUCED THEM. NEEDED BY THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION IN PROGRAM DIRECTION, COMPLIANCE, AND STANDARDS SETTING. THIRTY STATES VOLUNTARILY PROVIDE INFORMATION FROM STATE WORKERS' COMPENSATION RECORDS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
SUPPLEMENTARY DATA SYSTEM

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30	0	0	30	0	0
Annual Time Burden (Hours)	324,600	0	0	324,600	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/12/1984

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