Survey of Occupational Injuries and Illnesses

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form BLS-9300-IDCF 2012 IDCF 1st Mailing	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spanish Data Collection Book	Form and Instruction	Unchanged	Available
Form IDCF Screen Shots IDCF Screen shots	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF IDCF 1st Mailing (DJTR)	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spani SOII Spanish Data Collection Book	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spani SOII Spanish Book Second Non Response	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spani SOII Spanish Book 1st Non-Response	Form and Instruction	Unchanged	Available
Form BLS 9300 FAX SOII Fax Form	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Adobe Fillable Form	Form and Instruction	Unchanged	Available
Form 9300 IDCF BLS IDCF and SOII Instrument Screen Shots	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 SOII 1st Mailing	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF IDCF 1st Mailing (non DJTR)	Form and Instruction	Unchanged	Available
Form Attachment B Telephone Questionnaire	Form and Instruction	New	Available
Form Attachment B Telephone Questionnaire	Form and Instruction	New	Available
Form BLS 9300 IDCF SOII IDCF 1st Mailing - Voluntary	Form and Instruction	Unchanged	Available
Form BLS 9300 BLS IDCF and SOII Instrument Screen Shots	Form and Instruction	Unchanged	Available
Form BLS 9300 FAX SOII Fax form	Form and Instruction	Unchanged	Available
Form BLS 9300 SOII Adobe Form	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF SOII IDCF First Mailing (non DJTR)	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 SOII 1st Mailing	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF 2012 IDCF 1st Mailing	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spanish Data Collection	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF IDCF 1st Mailing (DJTR)	Form and Instruction	Unchanged	Available
Form IDCF SOII IDCF	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spanish Collection Booklet	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 SOII Spanish Collection Book 2nd Non-response	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 Spani SOII Spanish collection book 1st non-response	Form and Instruction	Unchanged	Available
Form BLS 9300 N06 SOII 1st Mailing	Form and Instruction	Unchanged	Available
Form BLS 9300 2012 Pre-Note Leaflet	Form and Instruction	Unchanged	Available
Form BLS 9300 Internet Pamphlet	Form and Instruction	Unchanged	Available
Form BLS 9300 FAX SOII Fax Form	Form and Instruction	Unchanged	Available
Form BLS 9300 SOII Adobe Form	Form and Instruction	Unchanged	Available
Form BLS 9300 IDCF IDCF 1st Mailing (non DJTR)	Form and Instruction	Unchanged	Available
Form BLS 9300 SOII IDCF and Instrument Screen shots	Form and Instruction	Unchanged	Available
Note to Reviewer (1220-0045) 4-30-2013.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-04-30	Available
Note to Reviewer - SOII forms changes 2012.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-09-05	Available
Note to Reviewer - SOII IDCF and ADOBE changes 2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-12-13	Available
Note to Reviewer - SOII IDCF and ADOBE changes 2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-12-13	Available
Note to Reviewer - SOII IDCF and ADOBE changes 2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-11-17	Available
Note to Reviewer - SOII forms changes 2011.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2011-09-21	Available
OMB2010 Supporting Statement Part B final 062810.docx	Supporting Statement B	Uploaded 2010-07-01	Available
OMB 2010 Supporting Statement Part A final 10062010.docx	Supporting Statement A	Uploaded 2010-10-06	Available
oshaforms.pdf	Supplementary Document	Uploaded 2010-05-04	Available
Deriving Inputs for the Allocation of State Samples for OMB Supporting Doc.docx	Supplementary Document	Uploaded 2010-04-23	Available
Variance Estimation for SOII Case and Demographic Estimates.docx	Supplementary Document	Uploaded 2010-04-23	Available
Variance Estimation forSOII Summary Estimates.pdf	Supplementary Document	Uploaded 2010-04-23	Available
Informed Consent.doc	Supplementary Document	Uploaded 2010-10-06	Available
Comm Order 1-06.doc	Supplementary Document	Uploaded 2010-04-22	Available
Secretary_Order_5-2002.doc	Supplementary Document	Uploaded 2010-04-22	Available
CIPSEA_TitleV.doc	Supplementary Document	Uploaded 2010-04-22	Available
Public Law 91-596.doc	Supplementary Document	Uploaded 2010-04-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	2012 IDCF 1st Mailing
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	Spanish Data Collection Book
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	IDCF Screen shots
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	IDCF 1st Mailing (DJTR)
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	SOII Spanish Data Collection Book
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	SOII Spanish Book Second Non Response
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	SOII Spanish Book 1st Non-Response
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	SOII Fax Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	Adobe Fillable Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	BLS IDCF and SOII Instrument Screen Shots
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	SOII 1st Mailing
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Unchanged	IDCF 1st Mailing (non DJTR)
206734	SOII Workplace Injuries and Illnesses Study - State and Local	Form and Instruction	New	Telephone Questionnaire
206733	SOII Workplace and Injuries Study - Private Sector	Form and Instruction	New	Telephone Questionnaire
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	SOII IDCF 1st Mailing - Voluntary
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	BLS IDCF and SOII Instrument Screen Shots
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	SOII Fax form
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	SOII Adobe Form
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	SOII IDCF First Mailing (non DJTR)
192801	Public Sector - Voluntary	Form and Instruction	Unchanged	SOII 1st Mailing
192801	Public Sector - Voluntary	Instruction	Unchanged
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	2012 IDCF 1st Mailing
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	Spanish Data Collection
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	IDCF 1st Mailing (DJTR)
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII IDCF
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	Spanish Collection Booklet
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII Spanish Collection Book 2nd Non-response
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII Spanish collection book 1st non-response
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII 1st Mailing
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	2012 Pre-Note Leaflet
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	Internet Pamphlet
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII Fax Form
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII Adobe Form
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	IDCF 1st Mailing (non DJTR)
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Unchanged	SOII IDCF and Instrument Screen shots

ICR Details

OMB Control No: 1220-0045	ICR Reference No: 201304-1220-003
Status: Historical Active	Previous ICR Reference No: 201209-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Survey of Occupational Injuries and Illnesses
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/21/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/07/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2013	10/31/2013	10/31/2013
Responses	243,900	0	240,000
Time Burden (Hours)	337,216	0	335,266
Cost Burden (Dollars)	0	0	0

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Abstract: The Survey of Occupational Injuries and Illnesses is the primary indicator of the Nation's progress in providing every working man and woman safe and healthful working conditions. Survey data are also used to evaluate the effectiveness of the Federal and State programs and to prioritize scarce resources.

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Authorizing Statute(s): PL: Pub.L. 91 - 596 24(a) Name of Law: Occupational Safety and Health Act of 1970
   PL: Pub.L. 107 - 347 Title 5 Name of Law: Confidential Information Protection and Statistical Efficiency Act (CIPSEA)
  

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:
	75 FR 20004	04/16/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 50005	08/16/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Public Sector - Voluntary	BLS 9300, BLS 9300, BLS 9300 N06, BLS 9300 IDCF, BLS 9300 FAX, BLS 9300 IDCF	SOII 1st Mailing ,   SOII IDCF First Mailing (non DJTR) ,   SOII Adobe Form ,   SOII Fax form ,   BLS IDCF and SOII Instrument Screen Shots ,   SOII IDCF 1st Mailing - Voluntary
SOII Workplace Injuries and Illnesses Study - State and Local	Attachment B	Telephone Questionnaire
SOII Workplace and Injuries Study - Private Sector	Attachment B	Telephone Questionnaire
Survey of Occupational Injuries and Illnesses - Private Sector	BLS 9300 IDCF, 9300 IDCF, BLS 9300 N06, BLS 9300 N06 Spanish, BLS 9300 N06 Spanish, BLS 9300 IDCF, BLS 9300 N06, BLS 9300 FAX, BLS 9300 N06 Spanish, IDCF Screen Shots, BLS 9300 N06, BLS-9300-IDCF	IDCF 1st Mailing (non DJTR) ,   SOII 1st Mailing ,   BLS IDCF and SOII Instrument Screen Shots ,   Adobe Fillable Form ,   SOII Fax Form ,   SOII Spanish Book 1st Non-Response ,   SOII Spanish Book Second Non Response ,   SOII Spanish Data Collection Book ,   IDCF 1st Mailing (DJTR) ,   IDCF Screen shots ,   Spanish Data Collection Book ,   2012 IDCF 1st Mailing
Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	BLS 9300 IDCF, BLS 9300, BLS 9300 IDCF, BLS 9300, BLS 9300 FAX, BLS 9300, BLS 9300, BLS 9300 N06, IDCF, BLS 9300 N06, BLS 9300 N06, BLS 9300 N06 Spanish, BLS 9300 N06, BLS 9300 IDCF	SOII IDCF and Instrument Screen shots ,   IDCF 1st Mailing (non DJTR) ,   SOII Adobe Form ,   SOII Fax Form ,   Internet Pamphlet ,   2012 Pre-Note Leaflet ,   SOII 1st Mailing ,   SOII Spanish collection book 1st non-response ,   SOII Spanish Collection Book 2nd Non-response ,   Spanish Collection Booklet ,   SOII IDCF ,   IDCF 1st Mailing (DJTR) ,   Spanish Data Collection ,   2012 IDCF 1st Mailing

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ICR Summary of Burden

table that charts list 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	243,900	240,000	0	3,900	0	0
Annual Time Burden (Hours)	337,216	335,266	0	1,950	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: The burden increase of 1950 is the result of a study to determine the undercount of workplace injuries and illnesses in the SOII survey.

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Annual Cost to Federal Government: $20,400,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 05/07/2013

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