Information Collection

Reporting Occupational Injuries and Illnesses

IC 212582 under ICR 201901-1218-001 · OMB 1218-0176.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1218-0176 can be found here:

Documents and Forms

Document Name Document Type
Form OSHA 6-40.1 Reporting Occupational Injuries and Illnesses Form and Instruction
OSHA 6-40.1 Serious Event Reporting Online Form Serious Event Reporting Online Form _ Occupational Safety and Health Administration (downloaded 01.18.19).pdf www.osha.gov/pls/ser/serform.html Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

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

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	OSHA 6-40.1	Serious Event Reporting Online Form	Serious Event Reporting Online Form _ Occupational Safety and Health Administration (downloaded 01.18.19).pdf	https://www.osha.gov/pls/ser/serform.html	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	20,000	20,000
Annual IC Time Burden (Hours)	10,000	10,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.