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

Occupational Safety and Health Administration Data Initiative (ODI)

Documents and Forms

Document Name Document Type
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

Information Collection (IC) Details

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			OSHA Form 196B Notification.pdf		No		Printable Only
Form and Instruction	196B	OSHA Work-Related Injury and Illness Data Collection	OSHA Form 196B Form and Instruction.pdf		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 %

	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

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.