Note to Reviewer

November 16, 2009

MEMORANDUM FOR : Reviewer of 1220-0045

FROM : Tom Shaffer, Chief

Division of Safety and Health Statistics

Office of Compensation and Working Conditions

Bureau of Labor Statistics

SUBJECT : New Fax Collection Form for the Survey of
Occupational Injuries and Illnesses

In January 2010, the Bureau of Labor Statistics (BLS) will begin using a revised fax collection form for the Survey of Occupational Injuries and Illnesses. BLS has conducted fax collection of this survey for several years as an option for respondents to provide data.

In an effort to improve respondent use of the form and ensure that data are not misrepresented, BLS has made some minor changes to the collection form. The changes to the form are detailed below.

• The revised form will be labeled by state. This will ensure that data are properly and easily transmitted to the appropriate state for data entry.

• In Section 1 of the revised form, the Establishment ID Number has been moved to the beginning of the sentence to make it more prominent for respondents.

• In Section 1, Item 3 of the revised form, the text after the No checkbox has been removed to ensure that respondents review all elements of the collection form to ensure that they are reporting all appropriate cases for the survey.

• In Section 2, the text box to the right of Number of Cases has been removed. These instructions have been included in the altered text that appears at the top of page 2. These instructions should more clearly explain the steps necessary to complete the survey.

• Finally, at the bottom of page 2 a text box has been added explaining where to fax the completed forms. Moving the submission instruction to the end of the form should help ensure that respondents read through both pages of the collection form.

The revised fax collection form is included with this note to the reviewer. This change is not expected to have an impact on respondent burden. If you have any questions about this request, please contact Tom Shaffer by telephone at 202-691-6163 or by e-mail at shaffer.tom@bls.gov.

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