Information Collection

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

IC 179004 under ICR 202004-1220-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 BLS 9300 Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
9300 IDCF - 2019 .docx	Instruction
Item 15 - 2019 SOII instructions sheet - nonDJTR OMB revision with OSHA ITA_20190923.docx	Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses 9300_SOII_SY2019_Long_Form OMB.doc	Form and Instruction
BLS 9300 FAX SOII FAX form 01_Alabama_2019.docx	Form and Instruction
BLS 9300 N06 SOII Spanish Data Collection Booklet Item 1 - 2019 SOII Spanish Data Collection Book OMB revision.docx	Form and Instruction
IDCF Screenshots SOII IDCF screenshots 2019 (002).docx	Form and Instruction
BLS 9300 FAX SOII FAX form English Fax form.pdf	Form and Instruction
BLS 9300 FAX SOII Fax form Spanish Fax form.pdf	Form and Instruction
Item 5 - 2020 SOII instructions sheet - Mand_prenote.docx 2020 Instruction sheet - manadatory prenote	IC Document
Item 17 - Non-Response letter 1_2019.docx Non-response Letter 1	IC Document
Item 18 - Non-Response letter 2.pdf Non-response letter 2	IC Document
SOII Informed Consent Letter.pdf SOII Informed consent letter	IC Document
Item 23 - Mandatory Pre-Notification_2020.docx Mandatory Prenote 2020	IC Document
Item 16 - 2019 Internet pamphlet.docx Internet Pamphlet	IC Document
Item 5 - 2020 Prenote Leaflet.docx Prenote Leaflet	IC Document
Data_Collection_email_message.docx Data Collection password email	IC Document
Mandatory_Prenote_email_message.docx Mandatory prenote email message	IC Document
Data_Collection_email_message.docx Data Collection email message	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS 9300	Survey of Occupational Injuries and Illnesses	9300_SOII_SY2019_Long_Form OMB.doc	Yes	Yes	Fillable Printable
Instruction			9300 IDCF - 2019 .docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	SOII FAX form	01_Alabama_2019.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	SOII Spanish Data Collection Booklet	Item 1 - 2019 SOII Spanish Data Collection Book OMB revision.docx	Yes	No	Fillable Printable
Instruction			Item 15 - 2019 SOII instructions sheet - nonDJTR OMB revision with OSHA ITA_20190923.docx	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	Screenshots	SOII IDCF screenshots 2019 (002).docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	SOII FAX form	English Fax form.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	SOII Fax form	Spanish Fax form.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 14,400

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14,400	14,400
Annual IC Time Burden (Hours)	9,084	9,084
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2020 Instruction sheet - manadatory prenote	Item 5 - 2020 SOII instructions sheet - Mand_prenote.docx	08/21/2019
Non-response Letter 1	Item 17 - Non-Response letter 1_2019.docx	08/21/2019
Non-response letter 2	Item 18 - Non-Response letter 2.pdf	04/17/2020
SOII Informed consent letter	SOII Informed Consent Letter.pdf	08/21/2019
Mandatory Prenote 2020	Item 23 - Mandatory Pre-Notification_2020.docx	08/21/2019
Internet Pamphlet	Item 16 - 2019 Internet pamphlet.docx	08/21/2019
Prenote Leaflet	Item 5 - 2020 Prenote Leaflet.docx	08/21/2019
Data Collection password email	Data_Collection_email_message.docx	08/21/2019
Mandatory prenote email message	Mandatory_Prenote_email_message.docx	08/21/2019
Data Collection email message	Data_Collection_email_message.docx	08/21/2019

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