Information Collection

Developing self-administered questions to collect occupational injury and illness classification data

IC 243629 under ICR 201708-1220-004 · OMB 1220-0141.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0141 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachments Developing self-administered questions to collect occupational injury and illness classification data	Form and Instruction
Apendix 4 OIICS.xlsx	Other-OIICS codes
Attachments Survey Protocol Attachments - Survey Protocol - HSOII studies.docx	Form and Instruction
Note to Reviewer - HSOII studies.docx Note to Reviewer - Developing self-administered questions to collect occupational injury and illness classification data	IC Document

IC Title:

Developing self-administered questions to collect occupational injury and illness classification data

Agency IC Tracking Number:

IC Status: New

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	Attachments	Survey Protocol	Attachments - Survey Protocol - HSOII studies.docx		Yes	Yes	Fillable Fileable
Other-OIICS codes			Apendix 4 OIICS.xlsx		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: 1,078

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,078	1,078
Annual IC Time Burden (Hours)	255	255
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Note to Reviewer - Developing self-administered questions to collect occupational injury and illness classification data	Note to Reviewer - HSOII studies.docx	09/14/2020

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