Information Collection

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

IC 179004 under ICR 202008-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 FAX SOII FAX form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form BLS 9300 Survey of Occupational Injuries and Illnesses Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form BLS 9300 N06 SOII Spanish Data Collection Booklet Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form IDCF Screenshots Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form BLS 9300 FAX SOII FAX form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Form BLS 9300 FAX SOII Fax form Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
9300 IDCF - 2019 .docx	Instruction
Item 000 - 2020 SOII instructions sheet - nonDJTRITA.docx	Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses SOII_SY2020_Long_Form OMB.docx	Form and Instruction
BLS 9300 FAX SOII FAX form AK_2020.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 Fax_form_English_2020 generic.docx	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_2020.docx 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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS 9300	Yes	Yes	Fillable Printable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	Yes	No	Fillable Printable
Instruction		Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 FAX	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		08/21/2019
Non-response Letter 1		08/21/2019
Non-response letter 2		08/06/2020
SOII Informed consent letter		08/21/2019
Mandatory Prenote 2020		08/21/2019
Internet Pamphlet		08/21/2019
Prenote Leaflet		08/21/2019
Data Collection password email		08/21/2019
Mandatory prenote email message		08/21/2019
Data Collection email message		08/21/2019

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

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