Information Collection

20 Cfr 702.111 Maintenance Of Records Of Injury/ Occupational Disease

IC 122193 under ICR 198307-1215-002 · OMB 1215-0117.

Documents and Forms

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Document Name	Document Type

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IC Title:

20 CFR 702.111 MAINTENANCE OF RECORDS OF INJURY/ OCCUPATIONAL DISEASE

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ESA-100LS				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	223,000	-31,000	254,000
Annual IC Time Burden (Hours)	4,460	-620	5,080
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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