View Information Collection (IC)

View Information Collection (IC)

IC Title:	Household Survey of Occupational Injuries and Illnesses Pilot Test (HSOII)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	HSOII Questionnaire	HSOII Questionnaire	HSOII Questionnaire REV 6.16.17.docx		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: 3,520	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	3,520	0	0	0	0	3,520
Annual IC Time Burden (Hours)	1,144	0	0	0	0	1,144
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
HSOII Letter	HSOII Letter.docx	01/24/2017
HSOII Screening/Recruitment	BLS HSOII Pretest recruitment on Cragslist20170306.docx	03/06/2017
Pilot Design	Westat Pilot Study Design Report.pdf	06/19/2017

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