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

Federal Form Document

Forms and Documents

Document Name	Status
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form	Modified
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form	Modified
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change	2024-03-19
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change	2024-03-19
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx Supporting Statement A	2024-01-29
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx Supporting Statement A	2024-01-29

IC Document Collections

IC ID	Document Title	Status
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