Information Collection

Census of Fatal Occupational Injuries - Federal Government

IC 14631 under ICR 202301-1220-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 - Federal Government	Form
Attachment 2B - Letter requesting source documents.docx	Instruction
Attachment 2B - Letter requesting source documents.docx	Instruction
CFOI -1 Census of Fatal Occupational Injuries Report CFOIS1702-FollowbackQuestionnaire_rev2023.01.10.pdf	Form
CFOI -1 Census of Fatal Occupational Injuries Report CFOIS1702-FollowbackQuestionnaire_rev20230508.pdf	Form

IC Title:

Census of Fatal Occupational Injuries - Federal 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFOI -1	Census of Fatal Occupational Injuries Report	CFOIS1702-FollowbackQuestionnaire_rev20230508.pdf		Yes	Yes	Fillable Printable
Instruction			Attachment 2B - Letter requesting source documents.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: 9

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 78 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	13	13
Annual IC Time Burden (Hours)	71	71
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.