Information Collection

Employer's First Report of Injury or Occupational Disease LS-202; Physician's Report on Impairment of Vision LS-205; Employer's Supplementary Report of Accident or Occupational Illness LS-210

IC 13652 under ICR 200107-1215-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 First Report of Injury or Occupational Disease LS-202; Physician's Report on Impairment of Vision LS-205; Employer's Supplementary Report of Accident or Occupational Illness LS-210	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-210	No	No
Form	LS-205	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 24,080	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	26,660	-3,330	29,990
Annual IC Time Burden (Hours)	6,705	-838	7,543
Annual IC Cost Burden (Dollars)	11,000	0	11,000

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.