Information Collection

Cognitive pre-testing of a survey on record-keeping practices in the Survey of Occupational Injuries and Illnesses (SOII)

IC 213093 under ICR 201111-1220-001 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 1 Cognitive pre-testing of a survey on record-keeping practices in the Survey of Occupational Injuries and Illnesses (SOII)	Form
Attachment 1 Interviewer Protocol Attachment 1 - Interview Protocol.docx	Form
Attachment 2 Screening Protocol Attachment 2 - Respondent screening protocol.docx	Form
Note to Reviewer - SOII Recontact Survey.doc Note to Reviewer - SOII Recontact Survey	IC Document

IC Title:

Cognitive pre-testing of a survey on record-keeping practices in the Survey of Occupational Injuries and Illnesses (SOII)

Agency IC Tracking Number:

21408

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Attachment 1	Interviewer Protocol	Attachment 1 - Interview Protocol.docx		Yes	No	Printable Only
Form	Attachment 2	Screening Protocol	Attachment 2 - Respondent screening protocol.docx		Yes	No	Printable Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - SOII Recontact Survey	Note to Reviewer - SOII Recontact Survey.doc	09/11/2014

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