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Federal forms, ICRs, and supporting documents

Information Collection Request

Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions

ICR 200703-1215-003 · OMB 1215-0204 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form LS-275-IC Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form Modified Available
Supporting Statement - 1215-0204 12-06.doc Supporting Statement A Uploaded 2007-05-02 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13942 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form Modified
ICR Details
1215-0204 200703-1215-003
Historical Active 200403-1215-004
DOL/ESA
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
Extension without change of a currently approved collection   No
Regular
Approved without change 09/20/2007
Retrieve Notice of Action (NOA) 05/22/2007
  Inventory as of this Action Requested Previously Approved
09/30/2010 36 Months From Approved 09/30/2007
646 0 728
434 0 470
288 0 0
The LS-275-IC; LS-275-SI and the LS-276 forms cover the submission of information by insurance carriers and self-insured employers regarding their ability to meet their financial obligations under the Longshore Act and its extensions.
US Code: 33 USC 932 Name of Law: Longshore and Harbor Workers' Compensation Act
  
None
Not associated with rulemaking
  72 FR 2308 01/18/2007
72 FR 28552 05/21/2007
No
  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 646 728 0 0 -82 0
Annual Time Burden (Hours) 434 470 0 0 -36 0
Annual Cost Burden (Dollars) 288 0 0 0 288 0
No
No
There is a decrease in the burden hours and cost burden is due to an adjustment in the number carriers that have withdrawn from the market. However, the costs appear new because the previous costs of $309.40 was not included in ROCIS (the pre-ROCIS system rounded this amount to $0).
$12,679
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Cheryl Jordan 202 693-0289 [email protected]
  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.
05/22/2007