Justification for Nonsubstantive Change to LS-202 Form

Justification for

Nonsubstantive/No Material Change Request for Employer’s First Report of Injury or Occupational Disease; Employer’s Supplementary Report of Accident or Occupational Illness

OMB Control No. 1240-0003 (March 2027)

The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) is requesting a non-substantive change to the approved collection of information contained in Employer’s First Report of Injury or Occupational Disease; Employer’s Supplementary Report of Accident or Occupational Illness. Specifically, OWCP seeks to update the LS-202 Form as follows:

1) Add an “Amended” checkbox at the top of the form so that the stakeholders can note that the filing is an “Amended” filing (without having to manually type in “AMENDED” as many of them do)

2) Add to Box 24 “(For DBA also include: name of the DOD facility or associated worksite – i.e. base, FOB, camp, etc.)”

3) Modify the “Box 24” instructions on the instructions page to account for the change noted in item number “2)” and add instructions for where to submit the completed form. The last bullet point for this item will now read: “If DBA, give the City, Country, Base, Camp, DOD facility or any additional information that will assist in determining exact location.” Following this bullet point, there will be a Submission instruction that reads: “SUBMISSION: The form can be uploaded via the SEAPortal (http://seaportal.dol.gov/portal/) or mailed to us at: U.S. Department of Labor Office of Workers’ Compensation Programs Division of Federal Employees’, Longshore and Harbor Workers’ Compensation 400 West Bay Street, Suite 63A, Box 28, Jacksonville, FL 32202”.

These minor changes do not impact burden.