Information Collection

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

IC 179004 under ICR 201312-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 BLS 9300 N06 Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
BLS 9300 IDCF - 2013 SOII instructions sheet - DJTR - Mandatory.pdf	Instruction
BLS 9300 IDCF - 2013 SOII instructions sheet - nonDJTR Mandatory.pdf	Instruction
BLS 9300 N06 Survey of Occupational Injuries and Illnesses BLS 9300 N06 - SOII_2013_Long_Form.pdf	Form and Instruction
BLS 9300 N06 Spanish Survey of Occupational Injuries and Illnesses BLS 9300 N06 - 2013 SOII Spanish Data Collection Book.pdf	Form and Instruction
BLS 9300 N06 Spanish Data Collection Non Response 1 BLS 9300 N06 - 2013 SOII Spanish Data Collection Book NR1.pdf	Form and Instruction
BLS 9300 N06 Spanish Data Collect Book Non Response 2 BLS9300 N06 - 2013 SOII Spanish Data Collection Book NR2.pdf	Form and Instruction
IDCF IDCF Screen Shots IDCF-SOII_ Screen Shots.docx	Form and Instruction
BLS 9300 FAX SOII FAX form FAX Form - 01_Alabama_2013.pdf	Form and Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses SOII PDF Form 2012.docx	Form and Instruction
IDCF IDCF Screen shots 2014 update IDCF-SOII_2013-compressed.docx	Form and Instruction
Mandatory DJTR letter data collection.pdf 2013 Data Collection letter DJTR	IC Document
2013 Non-Response letter 1 DJTR.pdf DJTR Non Response Letter 1	IC Document
2013 Non-Response letter 2 DJTR.pdf DJTR Non Response letter 2	IC Document
Non-Response letter 1 - Mandatory.pdf Non Response Letter 1 Non DJTR	IC Document
Non-Response letter 2 - mandatory.pdf Non Response Letter 2 Non DJTR	IC Document
2014 Mandatory_prenote.pdf 2014 Pre-note	IC Document
2014 Mandatory Pre-Notification-DJTR.pdf 2014 Pre Note DJTR	IC Document
Mandatory DJTR letter data collection.pdf 2012 DJTR Letter	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS 9300 N06	Survey of Occupational Injuries and Illnesses	BLS 9300 N06 - SOII_2013_Long_Form.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	Spanish Survey of Occupational Injuries and Illnesses	BLS 9300 N06 - 2013 SOII Spanish Data Collection Book.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	Spanish Data Collection Non Response 1	BLS 9300 N06 - 2013 SOII Spanish Data Collection Book NR1.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	Spanish Data Collect Book Non Response 2	BLS9300 N06 - 2013 SOII Spanish Data Collection Book NR2.pdf	Yes	Yes	Fillable Printable
Form and Instruction	IDCF	IDCF Screen Shots	IDCF-SOII_ Screen Shots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	SOII FAX form	FAX Form - 01_Alabama_2013.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	Survey of Occupational Injuries and Illnesses	SOII PDF Form 2012.docx	Yes	Yes	Fillable Fileable
Instruction			BLS 9300 IDCF - 2013 SOII instructions sheet - DJTR - Mandatory.pdf	Yes	Yes	Printable Only
Instruction			BLS 9300 IDCF - 2013 SOII instructions sheet - nonDJTR Mandatory.pdf	Yes	Yes	Printable Only
Form and Instruction	IDCF	IDCF Screen shots 2014 update	IDCF-SOII_2013-compressed.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13,000	13,000
Annual IC Time Burden (Hours)	8,417	8,417
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2013 Data Collection letter DJTR	Mandatory DJTR letter data collection.pdf	06/04/2013
DJTR Non Response Letter 1	2013 Non-Response letter 1 DJTR.pdf	06/04/2013
DJTR Non Response letter 2	2013 Non-Response letter 2 DJTR.pdf	06/04/2013
Non Response Letter 1 Non DJTR	Non-Response letter 1 - Mandatory.pdf	06/04/2013
Non Response Letter 2 Non DJTR	Non-Response letter 2 - mandatory.pdf	06/04/2013
2014 Pre-note	2014 Mandatory_prenote.pdf	06/04/2013
2014 Pre Note DJTR	2014 Mandatory Pre-Notification-DJTR.pdf	06/04/2013
2012 DJTR Letter	Mandatory DJTR letter data collection.pdf	06/04/2013

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