Information Collection

Employer's First Report of Injury or Occupational Illness Physicians Report on Impairment of Vision Employer's Supplementary Report of Accident or Occupational Ill.

IC 121880 under ICR 199506-1215-018 · OMB 1215-0031.

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Information Collection (IC) Details

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IC Title:

Employer's First Report of Injury or Occupational Illness Physicians Report on Impairment of Vision Employer's Supplementary Report of Accident or Occupational Ill.

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.	Available Electronically?	Can Be Submitted Electronically?
Form	LS-202	No	No
Form	LS-205	No	No
Form	LS-210	No	No

Federal Enterprise Architecture Business Reference Module

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 34,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	34,400	34,400	0
Annual IC Time Burden (Hours)	8,650	-2,758	11,408
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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Title	Document	Date Uploaded

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