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SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean.docx
Employer's First Report of Injury or Occupational Disease; Employer's Supplementary Report of Accident or Occupational Illness
OMB: 1240-0003
OMB.report
DOL/OWCP
OMB 1240-0003
ICR 202312-1240-001
SUPPORTING STATEMENT2023LS202 JP JM final_MN_clean
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0003 can be found here:
2024-03-19 - No material or nonsubstantive change to a currently approved collection
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