Bureau of Labor Statistics Occupational Safety and Health Statistics Cooperative Agreement Application Package

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OSHS FRW - A 2019 OSHS Cooperative Agreement	Form and Instruction	New	Available
1220-0149 Part A OSHS FY 2019 Supporting Statement A Final.docx	Supporting Statement A	Uploaded 2018-04-12	Available
OSHS FY 2019 Note to Reviewer (1220-0149).doc	Supplementary Document	Uploaded 2018-03-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
230476	2019 OSHS Cooperative Agreement	Form and Instruction	New

ICR Details

OMB Control No: 1220-0149	ICR Reference No: 201803-1220-001
Status: Historical Active	Previous ICR Reference No: 201706-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Bureau of Labor Statistics Occupational Safety and Health Statistics Cooperative Agreement Application Package
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/28/2018
	Date Received in OIRA: 04/27/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2021	36 Months From Approved	05/31/2018
Responses	445	0	406
Time Burden (Hours)	400	0	367
Cost Burden (Dollars)	0	0	0

---

Abstract: The BLS signs cooperative agreements with States, and political subdivisions thereof, to assist them in developing and administering programs that deal with occupational safety and health statistics and to arrange through these agreements for research to further the objectives of the Occupational Safety and Health Act.

---

Authorizing Statute(s): US Code: 29 USC 669 Name of Law: Occupational Safety and Health Act of 1970
   US Code: 29 USC 1 and 2 Name of Law: BLS Authorzing Statute
   US Code: 31 USC 6305 Name of Law: Federal Grant and Cooperative Agreement Act of 1977
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 54416	11/17/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 18592	04/27/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
2019 OSHS Cooperative Agreement	OSHS TCF, OSHS FRW - A, OSHS CA BV, OSHS CA, OSHS FRW - B, BLS-OSHS2, Property Listing	Financial Reconciliation Worksheet ,   Financial Reconciliation Worksheet ,   Quarterly Financial Report ,   Budget Variance Request Form ,   Property Listing ,   Transmittal and Certification Form ,   OSHS Cooperative Agreement Work Statement

---

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	445	406	0	39	0	0
Annual Time Burden (Hours)	400	367	0	33	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in response and burden is due to the addition of the OSHS Budget Variance form and the OSHS FRW-B AAMC form.

---

Annual Cost to Federal Government: $220,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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

---

Common Form ICR:  No

---

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: 04/27/2018

---