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

Survey of Occupational Injuries and Illnesses

OMB: 1220-0045

IC ID: 179004

⚠️ Notice: This information collection may be referencing outdated material.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

2023-11-06 - No material or nonsubstantive change to a currently approved collection
2023-08-01 - No material or nonsubstantive change to a currently approved collection

Documents and Forms

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
IDCF Screen shots SOII IDCF 2015 Screenshots (2).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 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:

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
Form and Instruction	IDCF	Screen shots	SOII IDCF 2015 Screenshots (2).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 %

	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

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.