Census of Fatal Occupational Injuries - State, local, and tribal government

Census of Fatal Occupational Injuries

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0133 can be found here:

Documents and Forms

Document Name Document Type
Form BLS CFOI-1 Census of Fatal Occupational Injuries - State, local, and tribal government Form and Instruction
Attachment 2C - FAX requesting death certificatesAttachment 2C.docx Instruction
Attachment 2B - Letter requesting source documents.docx Instruction
BLS CFOI-1 Census of Fatal Occupational Injuries Report CFOI-1.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Census of Fatal Occupational Injuries - State, local, and tribal government	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS CFOI-1	Census of Fatal Occupational Injuries Report	CFOI-1.docx	Yes	Yes	Fillable Fileable
Instruction			Attachment 2C - FAX requesting death certificatesAttachment 2C.docx	Yes	Yes	Fillable Fileable
Instruction			Attachment 2B - Letter requesting source documents.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: 274	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14,810	-320	15,130
Annual IC Time Burden (Hours)	2,477	-63	2,540
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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