Information Collection

The Supplementary Record Of Occupational Injuries & Illness, The Log & Summary Of Occupational Injuries & Illnesses, Brief Guide To Recordkeeping Requirements For Occupational

IC 122872 under ICR 199109-1218-001 · OMB 1218-0176.

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IC Title:	THE SUPPLEMENTARY RECORD OF OCCUPATIONAL INJURIES & ILLNESS, THE LOG & SUMMARY OF OCCUPATIONAL INJURIES & ILLNESSES, BRIEF GUIDE TO RECORDKEEPING REQUIREMENTS FOR OCCUPATIONAL	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 61,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	61,000	61,000
Annual IC Time Burden (Hours)	518,828	518,828
Annual IC Cost Burden (Dollars)	0	0

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