Bureau of Labor Statistics Occupational Safety and Health Statistics Cooperative Agreement Application Package

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OSHS TCF OSHS Cooperative Agreement	Form	New	Available
OSHS FY 2016 Supporting Statement (1220-0149) Final.docx	Supporting Statement A	Uploaded 2015-04-03	Available
OSHS FY 2016 Note to Reviewer (1220-0149).doc	Supplementary Document	Uploaded 2015-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
215287	OSHS Cooperative Agreement	Form	New

ICR Details

OMB Control No: 1220-0149	ICR Reference No: 201502-1220-007
Status: Historical Active	Previous ICR Reference No: 201502-1220-002
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Bureau of Labor Statistics Occupational Safety and Health Statistics Cooperative Agreement Application Package
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/19/2015
	Date Received in OIRA: 04/03/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved	05/31/2015
Responses	406	0	406
Time Burden (Hours)	367	0	367
Cost Burden (Dollars)	0	0	0

---

Abstract: The BLS signs cooperative agreements with States, and political subdivisions thereof, to assist them in developing and administering programs that deal with occupational safety and health statistics and to arrange through these agreements for research to further the objectives of the Occupational Safety and Health Act. The Occupational Safety and Health Statistics Cooperative Agreement application package attached here for approval is representative of the package sent every year to the State agencies and is, therefore, considered a generic package. This package submits the updates for the FY 2015 agreement.

---

Authorizing Statute(s): US Code: 31 USC 6305 Name of Law: Federal Grant and Cooperative Agreement Act of 1977
   US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act of 1970
   US Code: 29 USC 1 and 2 Name of Law: BLS Authorzing Statute
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 67194	11/12/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 18259	04/03/2015
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
OSHS Cooperative Agreement	OSHS CA, OSHS FRW, OSHS TCF, BLS OSHS PL, BLS OSHS2	OSHS Transmittal and Certification Form ,   BLS OSHS Property Listing ,   BLS-OSHS Quareterly Financial Report ,   BLS OSHS Financial Reconciliation Worksheet ,   OSHS Cooperative Agreement - FY 2016

---

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	406	406	0	0	0	0
Annual Time Burden (Hours)	367	367	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $200,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

Common Form ICR:  No

---

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: 04/03/2015

---