Information Collection

Employer's Report Of Injury Or Occupational Illness Physicians Report On Impairment Of Vision

IC 168388 under ICR 198309-1215-022 · OMB 1215-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0031 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	EMPLOYER'S REPORT OF INJURY OR OCCUPATIONAL ILLNESS PHYSICIANS REPORT ON IMPAIRMENT OF VISION	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	LS-202,	No	No
Form	202A, 210,	No	No
Form	205	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 209,168	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	259,304	0	0	259,304
Annual IC Time Burden (Hours)	92,143	-14,990	55	107,078
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded

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