OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness

IC 13653 under ICR 202403-1240-002 · OMB 1240-0003.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.202 20 CFR 702.407 20 CFR 702.201

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form LS-210 Employer's Supplementary Report of Accident or Occupational Illness ls-210 (002).pdf http://www.dol.gov/owcp/dlhwc/ls-210.pdf Yes No Fillable Printable
Form and Instruction LS-202 Employer's First Report of Injury or Occupational Illness ls-202 3-19-24.pdf https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-202.pdf Yes Yes Fillable Fileable

Income Security General Retirement and Disability

DOL/OWCP-3  58 FR 49599

43,039 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   98 %

  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 43,039 0 0 0 0 43,039
Annual IC Time Burden (Hours) 10,760 0 0 0 0 10,760
Annual IC Cost Burden (Dollars) 611 0 0 0 0 611

Title Document Date Uploaded
DLHWC SEA Portal DLHWC Seaportal.pdf 09/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.