OMB control number

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

OMB 1240-0003 · DOL/OWCP.

OMB 1240-0003

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.

The latest form for Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness expires 2027-03-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx Supporting Statement A
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx Supporting Statement A
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form

All Historical Document Collections

202403-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-03-19
202312-1240-001	Revision of a currently approved collection	2024-02-09
202002-1240-002	Revision of a currently approved collection	2020-06-25
201611-1240-004 Approved without change	Extension without change of a currently approved collection	2017-03-08
201506-1240-006 Approved without change	Revision of a currently approved collection	2015-06-05
201412-1240-002 Preapproved	No material or nonsubstantive change to a currently approved collection	2015-03-12
201409-1240-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2014-09-30
201309-1240-001 Approved without change	Revision of a currently approved collection	2014-01-30
201007-1240-001 Approved without change	Extension without change of a currently approved collection	2010-12-17
201003-1240-003 Approved without change	Revision of a currently approved collection	2010-03-12