Survey of Occupational Injuries and Illnesses

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form IDCF Screenshots	Form and Instruction	Modified	Available
Form BLS 9300 FAX SOII FAX Response Form	Form and Instruction	Modified	Available
Form BLS 9300 N06 SOII Spanish 2nd nonresponse	Form and Instruction	Modified	Available
Form BLS 9300 N06 SOII Spanish NR1	Form and Instruction	Modified	Available
Form BLS-9300 N06 SOII Spanish version	Form and Instruction	Modified	Available
Form BLS-9300 N06 SOII Long Form	Form and Instruction	Modified	Available
Form IDCF SOII IDCF Screenshots 2014 updates	Form and Instruction	Modified	Available
Form IDCF IDCF Screenshots	Form and Instruction	Modified	Available
Form BLS 9300 Survey Of Occupational Injuries and Illnesses	Form and Instruction	Modified	Available
Form Attachment A Telephone Questionnaire	Form and Instruction	Unchanged	Available
Form IDCF Screenshots	Form and Instruction	Modified	Available
Form BLS 9300 N06 SOII Collection Form	Form and Instruction	Modified	Available
Form IDCF IDCF SOII 2014 update	Form and Instruction	Modified	Available
Form SOII PDF SOII PDF	Form and Instruction	Modified	Available
Form IDCF IDCF Screen Shots	Form and Instruction	Modified	Available
Form IDCF Screen shots	Form and Instruction	Modified	Available
Form BLS 9300 FAX SOII Fax form	Form and Instruction	Modified	Available
Form BLS 9300 N06 Spanish Nonresponse 2	Form and Instruction	Modified	Available
Form BLS 9300 N06 Spanish Nonresponse 1	Form and Instruction	Modified	Available
Form BLS 9300 N06 SOII Collection Form - Spanish	Form and Instruction	Modified	Available
Form BLS-9300 N06 2014 SOII Collection Form	Form and Instruction	Modified	Available
Form IDCF IDCF Screen shots 2014 update	Form and Instruction	Modified	Available
Form BLS 9300 Survey of Occupational Injuries and Illnesses	Form and Instruction	Modified	Available
Form IDCF IDCF Screen Shots	Form and Instruction	Modified	Available
Note to Reviewer - SOII IDCF changes 2015.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-11-19	Available
Note to Reviewer - SOII re-contact survey (1-13-15).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-01-13	Available
Note to Reviewer - SOII forms changes 2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2014-09-10	Available
Note to Reviewer - SOII IDCF changes 2014.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2013-12-09	Available
Report on DJTR.pdf	Supplementary Document	Uploaded 2013-09-30	Available
OMB 2013 Supporting Statement Part A 09-27-2013.docx	Supporting Statement A	Uploaded 2013-09-27	Available
OMB 1220-0045 Part B 2013-07-10.docx	Supporting Statement B	Uploaded 2013-07-17	Available
Secretary_Order_5-2002.doc	Supplementary Document	Uploaded 2013-06-04	Available
homch9.pdf	Supplementary Document	Uploaded 2013-06-04	Available
The growth in cases with Restricted Activity or Job Transfer.docx	Supplementary Document	Uploaded 2013-06-04	Available
sample_overview.pdf	Supplementary Document	Uploaded 2013-06-04	Available
Deriving Inputs for the Allocation of State Samples for OMB Supporting Doc.docx	Supplementary Document	Uploaded 2013-06-04	Available
Variance Estimation for SOII Case and Demographic Estimates.docx	Supplementary Document	Uploaded 2013-06-04	Available
Variance Estimation for SOII Summary Estimates.pdf	Supplementary Document	Uploaded 2013-06-04	Available
CIPSEA_TitleV.doc	Supplementary Document	Uploaded 2013-05-22	Available
Public Law 91-596.doc	Supplementary Document	Uploaded 2013-05-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	Screenshots
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII FAX Response Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII Spanish 2nd nonresponse
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII Spanish NR1
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII Spanish version
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII Long Form
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	SOII IDCF Screenshots 2014 updates
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	IDCF Screenshots
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Form and Instruction	Modified	Survey Of Occupational Injuries and Illnesses
38596	Survey of Occupational Injuries and Illnesses - Private Sector	Instruction	Modified
214230	SOII Recontact Survey	Form and Instruction	Unchanged	Telephone Questionnaire
214230	SOII Recontact Survey	Instruction	Unchanged
192801	Public Sector - Voluntary	Form and Instruction	Modified	Screenshots
192801	Public Sector - Voluntary	Form and Instruction	Modified	SOII Collection Form
192801	Public Sector - Voluntary	Form and Instruction	Modified	IDCF SOII 2014 update
192801	Public Sector - Voluntary	Form and Instruction	Modified	SOII PDF
192801	Public Sector - Voluntary	Form and Instruction	Modified	IDCF Screen Shots
192801	Public Sector - Voluntary	Instruction	Modified
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	Screen shots
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	SOII Fax form
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	Spanish Nonresponse 2
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	Spanish Nonresponse 1
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	SOII Collection Form - Spanish
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	2014 SOII Collection Form
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	IDCF Screen shots 2014 update
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	Survey of Occupational Injuries and Illnesses
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction	Modified	IDCF Screen Shots
179004	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Instruction	Modified

ICR Details

OMB Control No: 1220-0045	ICR Reference No: 201511-1220-004
Status: Historical Active	Previous ICR Reference No: 201412-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Survey of Occupational Injuries and Illnesses
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/07/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/20/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2016	09/30/2016	09/30/2016
Responses	243,613	0	243,613
Time Burden (Hours)	337,379	0	337,379
Cost Burden (Dollars)	0	0	0

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Abstract: The Survey of Occupational Injuries and Illnesses is the primary indicator of the Nation's progress in providing every working man and woman safe and healthful working conditions. Survey data are also used to evaluate the effectiveness of the Federal and State programs and to prioritize scarce resources.

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Authorizing Statute(s): PL: Pub.L. 107 - 347 Title 5 Name of Law: Confidential Information Protection and Statistical Efficiency Act (CIPSEA)
   PL: Pub.L. 91 - 596 24(a) Name of Law: Occupational Safety and Health Act of 1970
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 29383	05/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 52564	08/23/2013
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Public Sector - Voluntary	IDCF, BLS 9300 N06, IDCF, SOII PDF, IDCF	IDCF Screen Shots ,   SOII PDF ,   IDCF SOII 2014 update ,   SOII Collection Form ,   Screenshots
SOII Recontact Survey	Attachment A	Telephone Questionnaire
Survey of Occupational Injuries and Illnesses - Private Sector	BLS-9300 N06, BLS-9300 N06, BLS 9300 N06, BLS 9300 N06, BLS 9300 FAX, BLS 9300, IDCF, IDCF, IDCF	Survey Of Occupational Injuries and Illnesses ,   IDCF Screenshots ,   SOII IDCF Screenshots 2014 updates ,   SOII Long Form ,   SOII Spanish version ,   SOII Spanish NR1 ,   SOII Spanish 2nd nonresponse ,   SOII FAX Response Form ,   Screenshots
Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	BLS 9300 N06, BLS 9300 FAX, IDCF, BLS-9300 N06, BLS 9300 N06, BLS 9300 N06, IDCF, BLS 9300, IDCF	IDCF Screen Shots ,   Survey of Occupational Injuries and Illnesses ,   IDCF Screen shots 2014 update ,   2014 SOII Collection Form ,   SOII Collection Form - Spanish ,   Spanish Nonresponse 1 ,   Spanish Nonresponse 2 ,   SOII Fax form ,   Screen shots

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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	243,613	243,613	0	0	0	0
Annual Time Burden (Hours)	337,379	337,379	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:

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Annual Cost to Federal Government: $19,000,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

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Common Form ICR:  No

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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: 11/20/2015

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