Information Collection

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

IC 179004 under ICR 202111-1220-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Form and Instruction
Item 15 - IDCF - Instructions 2021.docx	Instruction
Item 15 - IDCF - Instructions 2021.docx	Instruction
BLS 9300 FAX SOII FAX form AK_2021 with DART.docx	Form and Instruction
BLS 9300 FAX SOII FAX form AK_2021 with DART.docx	Form and Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses 2021 SOII_SY2021_Long_Form.docx	Form and Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses 2021 SOII_SY2021_Long_Form.docx	Form and Instruction
Form 9300 SOII Spanish Data Collection Book Item 1 - 2021 SOII Spanish Data Collection Book OMB revision.docx	Form and Instruction
Form 9300 SOII Spanish Data Collection Book Item 1 - 2021 SOII Spanish Data Collection Book OMB revision.docx	Form and Instruction
BLS 9300 FAX SOII Fax Form Item 24 - Fax_form_English_2021 updated for DART.docx	Form and Instruction
BLS 9300 FAX SOII Fax Form Item 24 - Fax_form_English_2021 updated for DART.docx	Form and Instruction
BLS 9300 Fax SOII Fax Form Spanish Fax_form_PR_2021_with DART.docx	Form and Instruction
BLS 9300 Fax SOII Fax Form Spanish Fax_form_PR_2021_with DART.docx	Form and Instruction
IDCF SOII IDCF Screenshots OMB_IDCF_Screenshots_20210726.docx	Form and Instruction
IDCF SOII IDCF Screenshots OMB_IDCF_Screenshots_20210726.docx	Form and Instruction
SOII Informed Consent Letter.pdf SOII Informed consent letter	IC Document
SOII Informed Consent Letter.pdf SOII Informed consent letter	IC Document
collection mandatory pass.msg Data Collection password email	IC Document
collection mandatory pass.msg Data Collection password email	IC Document
prenote mandatory 2022.msg Mandatory prenote email message	IC Document
prenote mandatory 2022.msg Mandatory prenote email message	IC Document
collection mandatory 2021.msg Data Collection email message	IC Document
collection mandatory 2021.msg Data Collection email message	IC Document
Item 5 - 2022 Prenote Leaflet.docx Item 5 2022 Prenote Leaflet	IC Document
Item 5 - 2022 Prenote Leaflet.docx Item 5 2022 Prenote Leaflet	IC Document
Item 17 - Non-Response letter 1_2021.docx Item 17 Non Response Letter 1 2021	IC Document
Item 17 - Non-Response letter 1_2021.docx Item 17 Non Response Letter 1 2021	IC Document
Item 18 - Non-Response letter 2_2021 with fax option.docx Item 18 Nonresponse Letter 2	IC Document
Item 18 - Non-Response letter 2_2021 with fax option.docx Item 18 Nonresponse Letter 2	IC Document
Item 16 - 2021 Internet pamphlet.docx Item 16 - 2021 Internet Pamphlet	IC Document
Item 16 - 2021 Internet pamphlet.docx Item 16 - 2021 Internet Pamphlet	IC Document
Item 23 - Mandatory Pre-Notification_2022.docx Ite 23 - Mandatory Pre-Note 2022	IC Document
Item 23 - Mandatory Pre-Notification_2022.docx Ite 23 - Mandatory Pre-Note 2022	IC Document
prenote mandatory pass.msg Prenote manadatory password email	IC Document
prenote mandatory pass.msg Prenote manadatory password email	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 FAX	SOII FAX form	AK_2021 with DART.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300	Survey of Occupational Injuries and Illnesses 2021	SOII_SY2021_Long_Form.docx	Yes	Yes	Fillable Printable
Instruction			Item 15 - IDCF - Instructions 2021.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Form 9300	SOII Spanish Data Collection Book	Item 1 - 2021 SOII Spanish Data Collection Book OMB revision.docx	Yes	Yes	Fillable Printable
Form and Instruction	BLS 9300 FAX	SOII Fax Form	Item 24 - Fax_form_English_2021 updated for DART.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 Fax	SOII Fax Form Spanish	Fax_form_PR_2021_with DART.docx	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	SOII IDCF Screenshots	OMB_IDCF_Screenshots_20210726.docx	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: 14,800

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	14,800	14,800
Annual IC Time Burden (Hours)	8,830	8,830
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
SOII Informed consent letter	SOII Informed Consent Letter.pdf	08/21/2019
Data Collection password email	collection mandatory pass.msg	07/28/2021
Mandatory prenote email message	prenote mandatory 2022.msg	07/28/2021
Data Collection email message	collection mandatory 2021.msg	07/28/2021
Item 5 2022 Prenote Leaflet	Item 5 - 2022 Prenote Leaflet.docx	06/28/2021
Item 17 Non Response Letter 1 2021	Item 17 - Non-Response letter 1_2021.docx	06/28/2021
Item 18 Nonresponse Letter 2	Item 18 - Non-Response letter 2_2021 with fax option.docx	06/28/2021
Item 16 - 2021 Internet Pamphlet	Item 16 - 2021 Internet pamphlet.docx	06/28/2021
Ite 23 - Mandatory Pre-Note 2022	Item 23 - Mandatory Pre-Notification_2022.docx	06/28/2021
Prenote manadatory password email	prenote mandatory pass.msg	07/28/2021

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