Information Collection

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

IC 182258 under ICR 202503-1220-004 · OMB 1220-0133.

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
Form CFOI 1 Census of Fatal Occupational Injuries Report Census of Fatal Occupational Injuries - State, local, and tribal government	Form
Form Attachment 2C FAX requesting death certificates Census of Fatal Occupational Injuries - State, local, and tribal government	Form and Instruction
2025_CFOI_Attachment2B_Letter_requesting_source_documents.docx	Instruction
2025_CFOI_Attachment2B_Letter_requesting_source_documents.docx	Instruction
CFOI 1 Census of Fatal Occupational Injuries Report 2025_CFOI-1_Final.docx	Form
CFOI 1 Census of Fatal Occupational Injuries Report 2025_CFOI-1_Final.docx	Form
Attachment 2C FAX requesting death certificates 2025_CFOI_Attachment2C_FAX_requesting_death_certificates.docx	Form and Instruction
Attachment 2C FAX requesting death certificates 2025_CFOI_Attachment2C_FAX_requesting_death_certificates.docx	Form and Instruction

IC Title:

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.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFOI 1	Yes	No	Fillable Printable
Instruction		Yes	No	Printable Only
Form and Instruction	Attachment 2C	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: 240

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	15,876	371	15,505
Annual IC Time Burden (Hours)	2,650	59	2,591
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.

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