OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Air Force Safety Automated System (AFSAS) Preliminary Mishap/Incident Reporting

ICR 202002-0701-001 · OMB 0701-0164 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form AF 978 Supervisor's Preliminary Mishap/Incident Report Form New Available
0701-AFSA_SSA_7.9.2020.docx Supporting Statement A Uploaded 2020-07-14 Available
AFSAS PIA dd2930 27 Jan 2020.pdf Supplementary Document Uploaded 2020-02-14 Available
AFSAS SORN final 10 May 2019.docx Supplementary Document Uploaded 2020-02-14 Available
IC Document Collections
IC IDCollectionTypeStatusForm
239987 Supervisor's Preliminary Mishap/Incident Report Form New
ICR Details
0701-0164 202002-0701-001
Active
DOD/AF 0701-AFSA
Air Force Safety Automated System (AFSAS) Preliminary Mishap/Incident Reporting
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/24/2020
Retrieve Notice of Action (NOA) 07/14/2020
  Inventory as of this Action Requested Previously Approved
08/31/2023 36 Months From Approved
200 0 0
200 0 0
1,450 0 0
Information is collected of those Air Force & DoD personnel involved in mishaps and witnesses (could be members of the general public) to include names, age, and medical information (Injury Severity, Injured Body Part, and Injury Type). Information is collected for the purpose of reporting mishaps, and to have valid and reliable data in order to determine safety trends, implement the ORM process, prevent mishaps, preserve AF assets, and to save lives.
US Code: 10 USC 9013 Name of Law: Secretary of the Air Force, powers and duties
   EO: EO 12196 Name/Subject of EO: Occupational Safety and Health Administration’s reporting requirements
  
None
Not associated with rulemaking
  84 FR 10480 03/21/2019
85 FR 39169 06/30/2020
No
1
IC Title Form No. Form Name
Supervisor's Preliminary Mishap/Incident Report AF 978 Supervisor's Preliminary Mishap/Incident Report
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 200 0 0 200 0 0
Annual Time Burden (Hours) 200 0 0 200 0 0
Annual Cost Burden (Dollars) 1,450 0 0 1,450 0 0
Yes
Miscellaneous Actions
No
New collection.
$2,845,308
No
    Yes
    Yes
No
No
No
No
Frank Svet 505 846-1459
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
07/14/2020