Information Collection Request
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness
ICR 202403-1240-002 · OMB 1240-0003 · Active
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness |
Form | Modified | Available |
| Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness |
Form | Modified | Repair queued |
 Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-03-19 | Available |
| Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-03-19 | Repair queued |
| SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx |
Supporting Statement A | Uploaded 2024-01-29 | Available |
| SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx |
Supporting Statement A | Uploaded 2024-01-29 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13653 |  Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness |
Form | Modified | |
| 13653 | Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness |
Form | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0003 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202312-1240-001 |
| Date Submitted to OIRA | 2024-03-19 |
| Requested Expiration Date | 1969-12-31 |