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

ICR 202312-1240-001

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0003 can be found here:

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
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

ICR Details