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View ICR - OIRA Conclusion

OMB Control No: 1240-0003	ICR Reference No: 201409-1240-004
Status: Historical Active	Previous ICR Reference No: 201309-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Employer's First Report of Injury or Occupational Disease, Employer's Supplementary Report of Accident or Occupational Illness
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/07/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/30/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	03/31/2017	03/31/2017
Responses	28,829	0	28,829
Time Burden (Hours)	7,208	0	7,208
Cost Burden (Dollars)	14,126	0	14,126

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	28,829	28,829
Annual Time Burden (Hours)	7,208	7,208
Annual Cost Burden (Dollars)	14,126	14,126

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: No

Burden Reduction Due to:

Short Statement: Burden has been increased by 1,324 hours to reflect an adjustment in the number of injuries reported under the Act. The operation and maintenance cost has been increased by 4,217 from $9,909.00 to $14,126.00 due to an increase in the number of claims reported under the Act and an increase in postage costs. Instructions for the LS-210 have been changed slightly to request that the form be filed if the information has not already been reported on the LS-206 or LS-208.