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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

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:

table that charts list of 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

Federal Enterprise Architecture Business Reference Module

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 %

table that charts list of burden
	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

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.