OMB No. 1240-0003 form Updates

OMB No. 1240-0003 – Form Updates

LS-210

• Added instructions for submission of form – informs respondents of the central mailroom address for mailing and of the availability of electronic submission

• Changed office room number in Public Burden Statement – office relocated to another floor in the building

• Added expiration date of XX/XX/XXXX – the previous waiver to exclude expiration date is no longer necessary

• #12 – Removed “Firm Name” from Name of Employer – too restrictive

LS-202

• Added Non-Binary as an option for “sex” in #8 - in order to encompass all employees who may be injured in the course of their employment who do not identify as either male or female

• #24 – Added “city, state and country if outside the US” - eliminates the need for respondent to “see instructions on reverse”

• Changed office room number in Public Burden Statement – office relocated to another floor in the building

• Added expiration date of XX/XX/XXXX – the previous waiver to exclude expiration date is no longer necessary

• Added instructions to include regulatory reference, instructions for physician’s treatment and instructions for submission of form – provides clarity on frequently asked questions and informs respondents of the availability of electronic submission