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1240-0058 Supporting Statement_1-26-23_CLEAN
1240-0058 Supporting Statement_1-26-23_CLEAN.docx
Request for Intervention, Longshore and Harbor Workers' Compensation Act
OMB: 1240-0058
OMB.report
DOL/OWCP
OMB 1240-0058
ICR 202210-1240-001
1240-0058 Supporting Statement_1-26-23_CLEAN
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0058 can be found here:
2026-03-06 - Extension without change of a currently approved collection
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