Information Collection

Reporting Occupational Injuries and Illnesses

IC 212582 under ICR 201502-1218-004 · OMB 1218-0176.

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Information Collection (IC) Details

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IC Title:	Reporting Occupational Injuries and Illnesses	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 1904.39

Information Collection Instruments:

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

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 119,028	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 15 %

	Approved	Previously Approved
Annual Number of Responses for this IC	119,028	119,028
Annual IC Time Burden (Hours)	59,514	59,514
Annual IC Cost Burden (Dollars)	0	0

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