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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1240-0003
ICR Reference No:
201003-1240-003
Status:
Historical Active
Previous ICR Reference No:
200408-1215-001
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/12/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/12/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2010
36 Months From Approved
Responses
26,381
0
23,220
Time Burden (Hours)
6,595
0
5,835
Cost Burden (Dollars)
11,608
0
10,000
Abstract:
The LS-202 and LS-210 are used to report injuries, periods of disability, and medical treatment under the Longshore and Harbor Workers' Compensation Act.
Authorizing Statute(s):
US Code:
33 USC Chapter 18
Name of Law: Longshore and Harbor Worker's Compensation Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
72 FR 20564
04/25/2007
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 49319
08/28/2007
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness
LS-202, LS-210
Employer's Firt Report of Injury or Occupational Illness
,
Employer's Supplementary Report of Accident or Occupational Illness
ICR Summary of Burden
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
26,381
23,220
0
-60
3,221
0
Annual Time Burden (Hours)
6,595
5,835
0
-45
805
0
Annual Cost Burden (Dollars)
11,608
10,000
0
0
1,608
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Cutting Redundancy
Short Statement:
Burden has increased reflects an adjustment in the number of injuries reported under the Act. The burden decrease as a program change is because the LS-205 has been removed from this information collection. The operation and maintenance cost has increased from $10,000 to $11,607.64 which is an increase of $1,607.64 (rounded to $1,608.00) due to an increase in postage cost and the reporting under the Act.
Annual Cost to Federal Government:
$17,004
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Cheryl Jordan 202 693-0289 jordan.cheryl@dol.gov
Common Form ICR:
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:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(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;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
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.
Certification Date:
08/28/2007
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