Information Collection

Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory

IC 179004 under ICR 201809-1220-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 N06 Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory Form and Instruction
Item 000 - 2018 SOII instructions sheet - nonDJTR.pdf Instruction
Item 15 -- IDCF - 2018.pdf Instruction
BLS 9300 N06 SOII Form SOII_SY2018_Long_Form.pdf Form and Instruction
BLS 9300 Spanish SOII Form Item 1 - 2018 SOII Spanish Data Collection Book.pdf Form and Instruction
9300 FAX SOII Fax Form Fax form 2018 Example.pdf Form and Instruction
IDCF SOII IDCF SOII IDCF_20181004.docx Form and Instruction
Item 000 - 2019 SOII instructions sheet - Mand_prenote.pdf 2017 Prenote - Mand IC Document
Item 17 - Non-Response letter 1_2018.pdf Non-response Letter 1 IC Document
Item 18 - Non-Response letter 2_2018.pdf Nonresponse letter 2 IC Document
Data_collection_password RY2018.docx Data collection password email IC Document
Mandatory_Prenote 2019.docx Mandatory pre-note email IC Document
Data_Collection RY2018.docx Data Collection email message IC Document
SOII Informed Consent Letter.pdf Informed Consent Letter IC Document
Item 23 - Mandatory Pre-Notification_2019.pdf Mandatory prenotification IC Document
Item 16 -- 2018 Internet pamphlet.pdf Internet Pamphlet IC Document
Item 5 -- 2019 Prenote Leaflet.pdf 2018 Prenote leaflet IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Occupational Injuries and Ilnesses - State and Local - Mandatory	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 N06	SOII Form	SOII_SY2018_Long_Form.pdf	Yes	No	Fillable Printable
Instruction			Item 000 - 2018 SOII instructions sheet - nonDJTR.pdf	Yes	No	Fillable Printable
Form and Instruction	BLS 9300	Spanish SOII Form	Item 1 - 2018 SOII Spanish Data Collection Book.pdf	Yes	No	Fillable Printable
Instruction			Item 15 -- IDCF - 2018.pdf	Yes	No	Fillable Printable
Form and Instruction	9300 FAX	SOII Fax Form	Fax form 2018 Example.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	IDCF	SOII IDCF	SOII IDCF_20181004.docx	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: 13,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	13,000	0	13,000
Annual IC Time Burden (Hours)	9,476	434	9,042
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
2017 Prenote - Mand	Item 000 - 2019 SOII instructions sheet - Mand_prenote.pdf	10/10/2018
Non-response Letter 1	Item 17 - Non-Response letter 1_2018.pdf	10/10/2018
Nonresponse letter 2	Item 18 - Non-Response letter 2_2018.pdf	10/10/2018
Data collection password email	Data_collection_password RY2018.docx	10/10/2018
Mandatory pre-note email	Mandatory_Prenote 2019.docx	10/10/2018
Data Collection email message	Data_Collection RY2018.docx	10/10/2018
Informed Consent Letter	SOII Informed Consent Letter.pdf	06/30/2016
Mandatory prenotification	Item 23 - Mandatory Pre-Notification_2019.pdf	10/10/2018
Internet Pamphlet	Item 16 -- 2018 Internet pamphlet.pdf	10/10/2018
2018 Prenote leaflet	Item 5 -- 2019 Prenote Leaflet.pdf	10/10/2018

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