Information Collection

Employer's Report Of Injury Or Occupational Illness, Physicians' Report On Impairment Of Vision, And Employer's Supplementary Report Of Accident Or Occupational Illness

IC 121879 under ICR 199211-1215-001 · OMB 1215-0031.

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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, AND EMPLOYER'S SUPPLEMENTARY REPORT OF ACCIDENT OR OCCUPATIONAL ILLNESS	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	LS-205	No	No
Form	LS-210	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 45,410	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	45,410	45,410
Annual IC Time Burden (Hours)	11,408	11,408
Annual IC Cost Burden (Dollars)	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.