Information Collection

OSHA Data Initiative (State,Local or Tribal Gov't)

IC 45389 under ICR 201302-1218-004 · OMB 1218-0209.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 196B OSHA Work-Related Injury and Illness Data Collection OSHA Data Initiative (State,Local or Tribal Gov't)	Form and Instruction
OSHA Form 196B Notification.pdf	Instruction
196B OSHA Work-Related Injury and Illness Data Collection OSHA Form 196B Form and Instruction.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

1218-0209(2013)

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1904

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
Instruction					No		Printable Only
Form and Instruction	196B				Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 167

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 79 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	167	-33	200
Annual IC Time Burden (Hours)	28	-5	33
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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