BLS/OSHS Cooperative Agreement (Application Package)

Forms and Documents

Document Name	Status
Form OSHS CA OSHS Cooperative Agreement Form and Instruction	New
Supporting Statement (1220-0149) FINAL.docx Supporting Statement A	2012-03-13

IC Document Collections

IC ID	Document Title	Status
201527	OSHS Cooperative Agreement Form and Instruction	New

ICR Details

OMB Control No: 1220-0149	ICR Reference No: 201201-1220-002
Status: Historical Active	Previous ICR Reference No: 201104-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: BLS/OSHS Cooperative Agreement (Application Package)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/21/2012
	Date Received in OIRA: 04/18/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	36 Months From Approved	07/31/2012
Responses	406	0	290
Time Burden (Hours)	367	0	348
Cost Burden (Dollars)	0	0	0

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Abstract: The BLS signs cooperative agreements with States, and political subdivisions thereof, to assist them in developing and administering programs that deal with occupational safety and health statistics and to arrange through these agreements for research to further the objectives of the Occupational Safety and Health Act. The Occupational Safety and Health Statistics Cooperative Agreement application package attached here for approval is representative of the package sent every year to the State agencies and is, therefore, considered a

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Authorizing Statute(s): US Code: 29 USC 15 Name of Law: Occupational Safety and Health Act of 1970
   US Code: 29 USC 1 and 2 Name of Law: BLS Authorzing Statute
   US Code: 31 USC 6301-6308 Name of Law: Federal Grant and Cooperative Agreement Act of 1977
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 71076	11/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 23282	04/18/2012
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
OSHS Cooperative Agreement	OSHS CA, OSHS CA, BLS OSHS FRW, BLS OSHS TCF, BLS OSHS Property Listing, BLS OSHS 2	2013 OSHS Cooperative Agreement ,   BLS OSHS Financial Reconciliation Worksheet (FRW) ,   BLS OSHS Property Listing ,   Transmittal and Certification Form ,   BLS OSHS Quarterly Financial Report

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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	406	290	0	116	0	0
Annual Time Burden (Hours)	367	348	0	19	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Some States discontinued their Occupational Safety Health and Statistics cooperative statistical programs, decreasing the total respondents to 54, however, the inclusion of the OSHS TCF, OSHS FRW, and OSHS Property Listing increased the total estimated responses and burden hours.

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Annual Cost to Federal Government: $216,333

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 04/18/2012

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