Information Collection

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

IC 179004 under ICR 201409-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 IDCF Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
2014 SOII instructions sheet - DJTR.pdf	Instruction
2014 SOII instructions sheet - nonDJTR.pdf	Instruction
BLS-9300 IDCF - 2014.pdf	Instruction
IDCF IDCF Screen Shots IDCF-SOII_ Screen Shots.docx	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
BLS-9300 N06 2014 SOII Collection Form SOII_SY2014_Long_Form.pdf	Form and Instruction
BLS 9300 N06 SOII Collection Form - Spanish BLS-9300 N06 - SOII Spanish version.pdf	Form and Instruction
BLS 9300 N06 Spanish Nonresponse 1 BLS 9300 N06 -SOII Spanish Data Collection Book NR1.pdf	Form and Instruction
BLS 9300 N06 Spanish Nonresponse 2 BLS 9300 N06 - SOII Spanish Data Collection Book NR2.pdf	Form and Instruction
BLS 9300 FAX SOII Fax form BLS-9300 FAX - SOII Fax Response Form.pdf	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 Pre-Notification-DJTR.pdf 2014 Pre Note DJTR	IC Document
Mandatory DJTR letter data collection.pdf 2012 DJTR Letter	IC Document
2015 Mandatory_prenote.pdf 2015 Mandatory Prenote	IC Document
2015 Prenote Leaflet.pdf 2014 Prenote Leaflet	IC Document
2014 Internet pamphlet.pdf Internet Pamphlet	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	IDCF	IDCF Screen Shots	IDCF-SOII_ Screen Shots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	Survey of Occupational Injuries and Illnesses	SOII PDF Form 2012.docx	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	IDCF Screen shots 2014 update	IDCF-SOII_2013-compressed.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS-9300 N06	2014 SOII Collection Form	SOII_SY2014_Long_Form.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	SOII Collection Form - Spanish	BLS-9300 N06 - SOII Spanish version.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	Spanish Nonresponse 1	BLS 9300 N06 -SOII Spanish Data Collection Book NR1.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 N06	Spanish Nonresponse 2	BLS 9300 N06 - SOII Spanish Data Collection Book NR2.pdf	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 FAX	SOII Fax form	BLS-9300 FAX - SOII Fax Response Form.pdf	Yes	Yes	Fillable Fileable
Instruction			2014 SOII instructions sheet - DJTR.pdf	Yes	Yes	Printable Only
Instruction			2014 SOII instructions sheet - nonDJTR.pdf	Yes	Yes	Printable Only
Instruction			BLS-9300 IDCF - 2014.pdf	Yes	Yes	Printable Only

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 DJTR	2014 Mandatory Pre-Notification-DJTR.pdf	06/04/2013
2012 DJTR Letter	Mandatory DJTR letter data collection.pdf	06/04/2013
2015 Mandatory Prenote	2015 Mandatory_prenote.pdf	09/08/2014
2014 Prenote Leaflet	2015 Prenote Leaflet.pdf	09/08/2014
Internet Pamphlet	2014 Internet pamphlet.pdf	09/10/2014

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