Information Collection

2019 Occupational Illness and Injury Prevention Survey (OD)

IC 234682 under ICR 201906-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2019 Occupational Illness and Injury Prevention Survey (OD)	Form and Instruction
1 ED DOHS OIIP Survey screenshot 121818-ED-DOHS OIIP Survey Printscreen 2019.pdf	Form and Instruction
010819-ED-DOHS IIPS PRA Request.doc 2019 Occupational Illness and Injury Prevention Survey fast track	IC Document

IC Title:

2019 Occupational Illness and Injury Prevention Survey (OD)

Agency IC Tracking Number:

IC Status: Unchanged

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	1	ED DOHS OIIP Survey screenshot	121818-ED-DOHS OIIP Survey Printscreen 2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	3,500	3,500
Annual IC Time Burden (Hours)	292	292
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2019 Occupational Illness and Injury Prevention Survey fast track	010819-ED-DOHS IIPS PRA Request.doc	01/08/2019

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