Information Collection

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

IC 179004 under ICR 201004-1220-003 · OMB 1220-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BLS 9300 Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
BLS 9300 SOII IDCF and Instrument Screen shots BLS IDCF and SOII Instrument.pdf	Form and Instruction
BLS 9300 IDCF IDCF 1st Mailing 2010 SOII IDCF First Mailing rev.docx	Form and Instruction
BLS 9300 SOII Adobe Form 2010 Adobe fillable form example.pdf	Form and Instruction
BLS 9300 FAX SOII Fax Form Fax Collection Form 2010 - AL.pdf	Form and Instruction
BLS 9300 Internet Pamphlet 2010 Internet pamphlet rev.docx	Form and Instruction
BLS 9300 Pre-Note Leaflet 2011 Prenote Leaflet E-blank rev.docx	Form and Instruction
BLS 9300 N06 SOII 1st Mailing 2010 SOII First Mailing rev.docx	Form and Instruction
BLS 9300 N06 Spani SOII Spanish collection book 1st non-response 2010 SOII Spanish Data Collection Book First Non-Response.pdf	Form and Instruction
BLS 9300 N06 SOII Spanish Collection Book 2nd Non-response 2010 SOII Spanish Data Collection Book Second Non-Response.pdf	Form and Instruction
BLS 9300 N06 Spanish Collection Booklet 2010 SOII Spanish Data Collection Book.pdf	Form and Instruction
IDCF SOII IDCF SOII IDCF - SY 2009.pdf	Form and Instruction
2011 Mandatory Units Pre-Notification.pdf Mandatory Pre-Units Notification	IC Document
2010 Mandatory Units First Non-Response letter.pdf Mandatory 1st Unit Non-response	IC Document
SOII Non-Response letter 2.pdf Mandatory Units 2nd non-response letter	IC Document

IC Title:

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS 9300	SOII IDCF and Instrument Screen shots	BLS IDCF and SOII Instrument.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	SOII Adobe Form	2010 Adobe fillable form example.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	SOII Fax Form	Fax Collection Form 2010 - AL.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06 Spanish	SOII Spanish collection book 1st non-response	2010 SOII Spanish Data Collection Book First Non-Response.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	SOII Spanish Collection Book 2nd Non-response	2010 SOII Spanish Data Collection Book Second Non-Response.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	Spanish Collection Booklet	2010 SOII Spanish Data Collection Book.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	SOII IDCF	SOII IDCF - SY 2009.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	SOII 1st Mailing	2010 SOII First Mailing rev.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	Pre-Note Leaflet	2011 Prenote Leaflet E-blank rev.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	Internet Pamphlet	2010 Internet pamphlet rev.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 IDCF	IDCF 1st Mailing	2010 SOII IDCF First Mailing rev.docx	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	13,000	-12,000	25,000
Annual IC Time Burden (Hours)	8,417	-8,243	16,660
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mandatory Pre-Units Notification	2011 Mandatory Units Pre-Notification.pdf	05/04/2010
Mandatory 1st Unit Non-response	2010 Mandatory Units First Non-Response letter.pdf	05/04/2010
Mandatory Units 2nd non-response letter	SOII Non-Response letter 2.pdf	05/04/2010

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