Information Collection

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

IC 182258 under ICR 202206-1220-001 · OMB 1220-0133.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFOI-1	Census of Fatal Occupational Injuries Report	CFOI-1.docx	Yes	Yes	Fillable Printable
Instruction			Attachment 2B - Letter requesting source documents.docx	Yes	Yes	Fillable Printable
Instruction			Attachment 2C - FAX requesting death certificatesAttachment 2C.docx	Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 260

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,505	695	14,810
Annual IC Time Burden (Hours)	2,591	114	2,477
Annual IC Cost Burden (Dollars)	0	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.