Information Collection

Occupational Safety and Health Statistics Cooperative Agreement Application Package

IC 246000 under ICR 202102-1220-001 · OMB 1220-0149.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0149 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form BLS-OSHS2 Occupational Safety and Health Statistics Cooperative Agreement Application Package	Form and Instruction
BLS-OSHS2 BLS-OSHS Quarterly Financial Report BLS - OSHS2.pdf	Form and Instruction
BLS-OSHS2 BLS-OSHS Quarterly Financial Report BLS - OSHS2.pdf	Form and Instruction
OSHS CA BV OSHS Cooperative Agreement Budget Variance Request Form OSHS Budget Variance Form.pdf	Form and Instruction
OSHS CA BV OSHS Cooperative Agreement Budget Variance Request Form OSHS Budget Variance Form.pdf	Form and Instruction
BLS OSHS TCF Transmittal and Certification Form BLS - OSHS TCF.PDF	Form
BLS OSHS TCF Transmittal and Certification Form BLS - OSHS TCF.PDF	Form
BLS OSHS FRW-B:AAM BLS OSHS Financial Reconciliation Worksheet (FRW-B: AAMC OSHS FRW-B.PDF	Form and Instruction
BLS OSHS FRW-B:AAM BLS OSHS Financial Reconciliation Worksheet (FRW-B: AAMC OSHS FRW-B.PDF	Form and Instruction
BLS OSHS FRW-A: Ba BLS OSHS Financial Reconciliation Worksheet (FRW-A: Base OSHS FRW-A.PDF	Form and Instruction
BLS OSHS FRW-A: Ba BLS OSHS Financial Reconciliation Worksheet (FRW-A: Base OSHS FRW-A.PDF	Form and Instruction
BLS OSHS Property BLS OSHS Property Listing OSHS Property Listing.pdf	Form and Instruction
BLS OSHS Property BLS OSHS Property Listing OSHS Property Listing.pdf	Form and Instruction
OSHS CA OSHS Cooperative Agreement Package FY 2021 OSHS CA.DOCX	Form and Instruction
OSHS CA OSHS Cooperative Agreement Package FY 2022 OSHS CA Final Draft memo 6-7-2021.docx	Form and Instruction

IC Title:

Occupational Safety and Health Statistics Cooperative Agreement Application Package

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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-OSHS2	BLS-OSHS Quarterly Financial Report	BLS - OSHS2.pdf	Yes	Yes	Fillable Fileable Signable
Form and Instruction	OSHS CA BV	OSHS Cooperative Agreement Budget Variance Request Form	OSHS Budget Variance Form.pdf	Yes	Yes	Fillable Fileable Signable
Form	BLS OSHS TCF	Transmittal and Certification Form	BLS - OSHS TCF.PDF	Yes	Yes	Fillable Fileable Signable
Form and Instruction	BLS OSHS FRW-B:AAMC	BLS OSHS Financial Reconciliation Worksheet (FRW-B: AAMC Programs)	OSHS FRW-B.PDF	Yes	Yes	Fillable Fileable
Form and Instruction	BLS OSHS FRW-A: Base Programs	BLS OSHS Financial Reconciliation Worksheet (FRW-A: Base Programs)	OSHS FRW-A.PDF	Yes	Yes	Fillable Fileable
Form and Instruction	BLS OSHS Property Listing	BLS OSHS Property Listing	OSHS Property Listing.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	OSHS CA	OSHS Cooperative Agreement Package	FY 2022 OSHS CA Final Draft memo 6-7-2021.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: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	445	445
Annual IC Time Burden (Hours)	386	386
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.