Forms LS-202 and LS-210 are used to report injuries, periods of disability, and medical treatment under the Longshore and Harbor Workers' Compensation Act.
US Code:
33 USC Chapter 18
Name of Law: Longshore and Harbor Worker's Compensation Act
Burden has been increased by 1,324 hours to reflect an adjustment in the number of injuries reported under the Act. The operation and maintenance cost has been increased by 4,217 from $9,909.00 to $14,126.00 due to an increase in the number of claims reported under the Act and an increase in postage costs.
Instructions for the LS-210 have been changed slightly to request that the form be filed if the information has not already been reported on the LS-206 or LS-208.
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.
Form LS-210 Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness
Justification for non-material change.docx
Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness