OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness

OMB 1240-0003 · DOL/OWCP.

OMB 1240-0003

Forms LS-202 and LS-210 are used to report injuries, periods of disability, and medical treatment under the Longshore and Harbor Workers' Compensation Act.

The latest form for Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness expires 2027-03-31 and is listed under ICR 202403-1240-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational IllnessForm
Form LS-210 Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational IllnessForm
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change
Justification for No material Nonsubtantive Change Request - 1240-0003 LS-202_MN clean.docx Justification for No Material/Nonsubstantive Change
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docxSupporting Statement A
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docxSupporting Statement A
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202403-1240-002 No material or nonsubstantive change to a currently approved collection 2024-03-19 Approved without change
202312-1240-001 Revision of a currently approved collection 2024-02-09
202002-1240-002 Revision of a currently approved collection 2020-06-25
201611-1240-004 Extension without change of a currently approved collection 2017-03-08 Approved without change
201506-1240-006 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-002 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201409-1240-004 No material or nonsubstantive change to a currently approved collection 2014-09-30 Approved without change
201309-1240-001 Revision of a currently approved collection 2014-01-30 Approved without change
201007-1240-001 Extension without change of a currently approved collection 2010-12-17 Approved without change
201003-1240-003 Revision of a currently approved collection 2010-03-12 Approved without change