Information Collection

Household Survey of Occupational Injuries and Illnesses Pilot Test (HSOII)

IC 225295 under ICR 201706-1220-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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 HSOII Questionnair Household Survey of Occupational Injuries and Illnesses Pilot Test (HSOII)	Form and Instruction
HSOII Questionnair HSOII Questionnaire HSOII Questionnaire REV 6.16.17.docx	Form and Instruction
HSOII Letter.docx HSOII Letter	IC Document
BLS HSOII Pretest recruitment on Cragslist20170306.docx HSOII Screening/Recruitment	IC Document
Westat Pilot Study Design Report.pdf Pilot Design	IC Document

IC Title:

Household Survey of Occupational Injuries and Illnesses Pilot Test (HSOII)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HSOII Questionnaire	HSOII Questionnaire	HSOII Questionnaire REV 6.16.17.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,520	2,970	550
Annual IC Time Burden (Hours)	1,144	0	1,144
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HSOII Letter	HSOII Letter.docx	01/24/2017
HSOII Screening/Recruitment	BLS HSOII Pretest recruitment on Cragslist20170306.docx	03/06/2017
Pilot Design	Westat Pilot Study Design Report.pdf	06/19/2017

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