Information Collection

Survey of Occupational Injuries and Illnesses - Private Sector

IC 38596 under ICR 201706-1220-005 · OMB 1220-0045.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1220-0045 can be found here:

Documents and Forms

Document Name Document Type
Form BLS 9300 Survey of Occupational Injuries and Illnesses - Private Sector Form and Instruction
IDCF - 2016_revised.pdf Instruction
2016 SOII instructions sheet - DJTR_revised.pdf Instruction
2016 SOII instructions sheet - nonDJTR_revised.pdf Instruction
BLS 9300 Survey of Occupational Injuries and Illnesses SOII_SY2016_Long_Form.pdf Form and Instruction
IDCF IDCF Screen Shots SOII IDCF ADOBE Screenshots.docx Form and Instruction
BLS 9300 N06 SoII Data Collection Booklet - Spanish Version Item 1 - 2016 SOII Spanish Data Collection Book.pdf Form and Instruction
BLS9300 FAX SOII 2016 01_Alabama_2016.pdf Form and Instruction
2017 SOII instructions sheet - Mand_prenote_revised.pdf 2017 Prenote - Mandatory IC Document
Non-Response letter 1_2016_revised.pdf Non-response Letter 1 IC Document
Non-Response letter 2_2016_revised.pdf Non-response letter 2 IC Document
Non-Response letter 1 DJTR_2016.pdf Non-response letter 1 DJTR IC Document
Non-Response letter 2 DJTR_2016.pdf Non-response letter 2 - DJTR IC Document
Data_collection_password_email.docx Data Collection password email IC Document
Mandatory_Prenote_email_message.docx Mandatory Prenote email IC Document
SOII Informed Consent Letter.pdf Informed Consent Letter IC Document
Mandatory Pre-Notification-DJTR_2017.pdf Mandatory Prenote DJTR 2017 IC Document
Mandatory Pre-Notification_2017.pdf Mandatory Prenote 2017 IC Document
Mandatory DJTR letter data collection_2016.pdf Mandatory DJTR letter 2016 IC Document
2016 Internet pamphlet_revised.pdf 2016 Internet Pamphlet IC Document
2017 Prenote Leaflet_revised.pdf 2017 Prenote Leaflet IC Document
Data_Collection_email_message.docx Data Collection Email message IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Occupational Injuries and Illnesses - Private Sector	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	BLS 9300	Survey of Occupational Injuries and Illnesses	SOII_SY2016_Long_Form.pdf	Yes	Yes	Fillable Printable
Form and Instruction	IDCF	IDCF Screen Shots	SOII IDCF ADOBE Screenshots.docx	Yes	Yes	Fillable Fileable
Form and Instruction	BLS 9300 N06	SoII Data Collection Booklet - Spanish Version	Item 1 - 2016 SOII Spanish Data Collection Book.pdf	Yes	Yes	Fillable Printable
Instruction			IDCF - 2016_revised.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	BLS9300 FAX	SOII 2016	01_Alabama_2016.pdf	Yes	Yes	Fillable Fileable
Instruction			2016 SOII instructions sheet - DJTR_revised.pdf	Yes	Yes	Fillable Fileable
Instruction			2016 SOII instructions sheet - nonDJTR_revised.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 220,000	Number of Respondents for Small Entity: 104,849

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Farms, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	220,000	220,000
Annual IC Time Burden (Hours)	289,334	289,334
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2017 Prenote - Mandatory	2017 SOII instructions sheet - Mand_prenote_revised.pdf	09/19/2016
Non-response Letter 1	Non-Response letter 1_2016_revised.pdf	09/19/2016
Non-response letter 2	Non-Response letter 2_2016_revised.pdf	09/19/2016
Non-response letter 1 DJTR	Non-Response letter 1 DJTR_2016.pdf	06/29/2016
Non-response letter 2 - DJTR	Non-Response letter 2 DJTR_2016.pdf	06/29/2016
Data Collection password email	Data_collection_password_email.docx	06/29/2016
Mandatory Prenote email	Mandatory_Prenote_email_message.docx	06/29/2016
Informed Consent Letter	SOII Informed Consent Letter.pdf	06/29/2016
Mandatory Prenote DJTR 2017	Mandatory Pre-Notification-DJTR_2017.pdf	06/29/2016
Mandatory Prenote 2017	Mandatory Pre-Notification_2017.pdf	06/29/2016
Mandatory DJTR letter 2016	Mandatory DJTR letter data collection_2016.pdf	06/29/2016
2016 Internet Pamphlet	2016 Internet pamphlet_revised.pdf	09/19/2016
2017 Prenote Leaflet	2017 Prenote Leaflet_revised.pdf	09/19/2016
Data Collection Email message	Data_Collection_email_message.docx	06/30/2016

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