SOII Workplace Injuries and Illnesses Study - State and Local

Survey of Occupational Injuries and Illnesses

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.