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Request for Intervention, Longshore and Harbor Workers' Compensation Act
Request for Intervention, Longshore and Harbor Workers' Compensation Act
OMB: 1240-0058
IC ID: 237986
OMB.report
DOL/OWCP
OMB 1240-0058
ICR 202511-1240-001
IC 237986
( )
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Request for Intervention, Longshore and Harbor Workers' Compensation Act
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 702.315
20 CFR 702.134
20 CFR 702.301
20 CFR 702.312
20 CFR 702.142
20 CFR 702.102
20 CFR 702.321
20 CFR 702.311
20 CFR 702.242
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
LS-4
Attorney Fee Order Request
Attorney Fee Approval Request.pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
LS-5
Application for Special Fund
Application for Special Fund Relief.pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
LS-6
Commutation Application
Commutation Application.pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
LS-7
Request for Intervention
Request for Intervention.pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
LS-8
Settlement Approval Request Section 8(i)
Settlement Approval Request Section 8(i).pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
LS-9
Stipulation Approval Request
Stipulation Approval Request.pdf
https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
DOL/OWCP-3
FR Citation:
81 FR 25765
Number of Respondents:
21,176
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
21,176
0
0
8,762
0
12,414
Annual IC Time Burden (Hours)
5,828
0
0
2,639
0
3,189
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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