OMB control number

Report Of Personal Injury Or Loss Of Life

OMB 2115-0004 · DOT/USCG.

OMB 2115-0004

Latest Forms, Documents, and Supporting Material

Document Name
REPORT OF PERSONAL INJURY OR LOSS OF LIFE Form

All Historical Document Collections

198207-2115-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1982-07-12
198105-2115-003 Approved without change	Revision of a currently approved collection	1981-05-28
198101-2115-002 Approved without change	Revision of a currently approved collection	1981-01-15
198006-2115-002 Approved without change	Reinstatement with change of a previously approved collection	1980-06-10
197504-2115-002 Approved without change	Extension without change of a currently approved collection	1975-04-22