Information Collection

SOII Workplace Injuries and Illnesses Study - State and Local

IC 206734 under ICR 201305-1220-002 · OMB 1220-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0045 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment B SOII Workplace Injuries and Illnesses Study - State and Local	Form and Instruction
Attachment B Telephone Questionnaire Attachment B - Telephone Questionnaire.docx	Form and Instruction
Attachment A - Introductory letter.docx Attachment A - Introductory Letter	IC Document

IC Title:

SOII Workplace Injuries and Illnesses Study - State and Local

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	Attachment B	Telephone Questionnaire	Attachment B - Telephone Questionnaire.docx		Yes	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 101

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	101	101
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment A - Introductory Letter	Attachment A - Introductory letter.docx	04/30/2013

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