Information Collection

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

IC 179004 under ICR 201701-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 BLS 9300 N06 SOII Form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form BLS 9300 Spanish SOII Form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form 9300 FAX SOII Fax Form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form IDCF SOII IDCF Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
2016 SOII instructions sheet - nonDJTR_revised.pdf	Instruction
IDCF - 2016_revised.pdf	Instruction
BLS 9300 N06 SOII Form SOII_SY2016_Long_Form.pdf	Form and Instruction
BLS 9300 Spanish SOII Form Item 1 - 2016 SOII Spanish Data Collection Book.pdf	Form and Instruction
9300 FAX SOII Fax Form 01_Alabama_2016.pdf	Form and Instruction
IDCF SOII IDCF SOII IDCF ADOBE Screenshots.docx	Form and Instruction
2017 SOII instructions sheet - Mand_prenote_revised.pdf 2017 Prenote - Mand	IC Document
Non-Response letter 1_2016.pdf Non-response Letter 1	IC Document
Non-Response letter 2_2016.pdf Nonresponse letter 2	IC Document
Data_collection_password_email.docx Data collection password email	IC Document
Mandatory_Prenote_email_message.docx Mandatory pre-note email	IC Document
Data_Collection_email_message.docx Data Collection email message	IC Document
SOII Informed Consent Letter.pdf Informed Consent Letter	IC Document
Mandatory Pre-Notification_2017.pdf Mandatory prenotification	IC Document
2016 Internet pamphlet_revised.pdf Internet Pamphlet	IC Document
2017 Prenote Leaflet_revised.pdf 2017 Prenote leaflet	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: Unchanged

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	BLS 9300 N06	SOII Form	SOII_SY2016_Long_Form.pdf	Yes	No	Fillable Printable
Instruction			2016 SOII instructions sheet - nonDJTR_revised.pdf	Yes	No	Fillable Printable
Form and Instruction	BLS 9300	Spanish SOII Form	Item 1 - 2016 SOII Spanish Data Collection Book.pdf	Yes	No	Fillable Printable
Instruction			IDCF - 2016_revised.pdf	Yes	No	Fillable Printable
Form and Instruction	9300 FAX	SOII Fax Form	01_Alabama_2016.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	SOII IDCF	SOII IDCF ADOBE Screenshots.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 %

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
2017 Prenote - Mand	2017 SOII instructions sheet - Mand_prenote_revised.pdf	09/19/2016
Non-response Letter 1	Non-Response letter 1_2016.pdf	06/30/2016
Nonresponse letter 2	Non-Response letter 2_2016.pdf	06/30/2016
Data collection password email	Data_collection_password_email.docx	06/30/2016
Mandatory pre-note email	Mandatory_Prenote_email_message.docx	06/30/2016
Data Collection email message	Data_Collection_email_message.docx	06/30/2016
Informed Consent Letter	SOII Informed Consent Letter.pdf	06/30/2016
Mandatory prenotification	Mandatory Pre-Notification_2017.pdf	06/30/2016
Internet Pamphlet	2016 Internet pamphlet_revised.pdf	09/19/2016
2017 Prenote leaflet	2017 Prenote Leaflet_revised.pdf	09/19/2016

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