EMPLOYER'S REPORT OF INJURY OR OCCUPATIONAL ILLNESS PHYSICIANS REPORT ON IMPAIRMENT OF VISION

ICR 198309-1215-022

OMB: 1215-0031

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1215-0031 198309-1215-022
Historical Active 198003-1215-001
DOL/ESA
EMPLOYER'S REPORT OF INJURY OR OCCUPATIONAL ILLNESS PHYSICIANS REPORT ON IMPAIRMENT OF VISION
No material or nonsubstantive change to a currently approved collection   No
Emergency 09/06/1983
Approved with change 09/06/1983
Retrieve Notice of Action (NOA) 09/06/1983
  Inventory as of this Action Requested Previously Approved
03/31/1984 03/31/1984 03/31/1984
259,304 0 259,304
92,143 0 107,078
0 0 0

FORMS ARE USED TO NOTIFY THE SECRETARY OF LABOR OF INJURY OR DEATH TO AN EMPLOYEE RESULTING FROM A JOB RELATED DISEASE OR INJURY (PL92-576 AS AMENDED, SECTION 12A).

None
None


No

1
IC Title Form No. Form Name
EMPLOYER'S REPORT OF INJURY OR OCCUPATIONAL ILLNESS PHYSICIANS REPORT ON IMPAIRMENT OF VISION LS-202,, 202A, 210,, 205

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 259,304 259,304 0 0 0 0
Annual Time Burden (Hours) 92,143 107,078 0 -14,990 55 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/06/1983


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