Administration of the Longshore and Harbor Workers' Compensation Act

ICR 202012-1240-001

OMB: 1240-0014

Federal Form Document

ICR Details
1240-0014 202012-1240-001
Received in OIRA 202001-1240-002
DOL/OWCP
Administration of the Longshore and Harbor Workers' Compensation Act
No material or nonsubstantive change to a currently approved collection   No
Regular 12/15/2020
  Requested Previously Approved
10/31/2023 10/31/2023
53,842 53,842
20,752 20,752
786 9,525

The regulations and forms cover the submission of information relating to the processing of claims for benefits under the Longshore Act and extensions. A new form, LS-272 (Application to Write Insurance) is added to this collection.

US Code: 33 USC 944 Name of Law: Longshore and Harbor Workers' Compensation A
   US Code: 33 USC 939 Name of Law: Longshore and Harbor Workers' Compensation A
  
None

Not associated with rulemaking

  85 FR 11397 02/27/2020
85 FR 31228 05/22/2020
No

  Total Request 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 53,842 53,842 0 0 0 0
Annual Time Burden (Hours) 20,752 20,752 0 0 0 0
Annual Cost Burden (Dollars) 786 9,525 0 -8,739 0 0
No
No

$183,923
No
    Yes
    Yes
No
No
No
No
Cheryl Jordan 202 693-0289 jordan.cheryl@dol.gov

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/15/2020


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