Census of Fatal Occupational Injuries

Forms and Documents

Document Name	Status
Form CFOI - 1 Census of Fatal Occupational Injuries - State, local, and tribal government Form and Instruction	Modified
Form CFOI - 1 Census of Fatal Occupational Injuries - Private Sector Form and Instruction	Modified
Form CFOI - 1 Census of Fatal Occupational Injuries - Individuals Form and Instruction	Modified
Form CFOI - 1 Census of Fatal Occupational Injuries - Government Form and Instruction	Modified
Supporint Statement Part A final 2-24-2011.docx Supporting Statement A	2011-02-24
Attachments 2011.doc Supplementary Document	2011-01-06
Supporting Statement Part B (1220-0133) final 01-06-2010.docx Supporting Statement B	2011-01-06
SecretarysOrder5-2007.pdf Supplementary Document	2010-10-25
CIPSEA_TitleV.doc Supplementary Document	2010-10-25
Public Law 91-596.doc Supplementary Document	2010-10-25

IC Document Collections

IC ID	Document Title	Status
182258	Census of Fatal Occupational Injuries - State, local, and tribal government Form and Instruction	Modified
182257	Census of Fatal Occupational Injuries - Private Sector Form and Instruction	Modified
182256	Census of Fatal Occupational Injuries - Individuals Form and Instruction	Modified
14631	Census of Fatal Occupational Injuries - Government Form and Instruction	Modified

ICR Details

OMB Control No: 1220-0133	ICR Reference No: 201010-1220-003
Status: Historical Active	Previous ICR Reference No: 200710-1220-001
Agency/Subagency: DOL/BLS	Agency Tracking No:
Title: Census of Fatal Occupational Injuries
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/17/2011
	Date Received in OIRA: 02/25/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	03/31/2011
Responses	26,797	0	23,720
Time Burden (Hours)	4,073	0	3,763
Cost Burden (Dollars)	0	0	0

---

Abstract: The Census of Fatal Occupational Injuries provides policymakers and the public with comprehensive, verifiable, and timely measures of fatal work injuries. Data are complied from various Federal, State, and local sources and include information on how the incident occurred as well as various characteristics of the employers and the deceased worker. This information is used for surveillance of fatal work injuries and for developing prevention strategies.

---

Authorizing Statute(s): PL: Pub.L. 91 - 596 24 Name of Law: Occupational Safety and Health Act of 1970
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 64746	10/20/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 10624	02/25/2011
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Census of Fatal Occupational Injuries - Private Sector	CFOI - 1	Census of Fatal Occupational Injuries
Census of Fatal Occupational Injuries - Government	CFOI - 1	Census Of Fatal Occupational Injuries Report
Census of Fatal Occupational Injuries - State, local, and tribal government	CFOI - 1	Census of Fatal Occupational Report
Census of Fatal Occupational Injuries - Individuals	CFOI - 1	Census of Fatal Occupational Injuries Report

---

ICR Summary of Burden

	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	26,797	23,720	0	0	3,077	0
Annual Time Burden (Hours)	4,073	3,763	0	0	310	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The increase in Burden hours reflects higher totals of source documents and followback questionnaires received in years 2004 through 2008, the years on which the estimates are based.

---

Annual Cost to Federal Government: $3,900,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/25/2011

---