Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act

ICR 201309-1240-005 · OMB 1240-0014 · Historical Active

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0014 can be found here:

Forms and Documents

Document	Type	Status	Availability
Form LS-201 Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act	Form	Modified	Repair queued
WORKSHEET FOR OMB NO 1240-0014 Nov 2013.docx	Supplementary Document	Uploaded 2013-12-20	Repair queued
OMB - Supporting Statement for 1240-0014 - 513 changes 11-19-13.docx	Supporting Statement A	Uploaded 2013-11-20	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
43808	Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act	Form	Modified

ICR Details

OMB Control No: 1240-0014	ICR Reference No: 201309-1240-005
Status: Historical Active	Previous ICR Reference No: 201202-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/29/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/27/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved	08/31/2015
Responses	130,036	0	130,036
Time Burden (Hours)	44,955	0	44,950
Cost Burden (Dollars)	46,866	0	45,979

Abstract: The regulations and forms cover the submission of information relating to the processing of claims for benefits under the Longshore Act and extensions.

Authorizing Statute(s): US Code: 33 USC 901 et seq. Name of Law: Longshore and Harbor Workers' Compensation Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 57416	09/18/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 78389	12/26/2013
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act	LS-204 , LS-200 , LS-201 , LS-513 , LS-267 , LS-203 , LS-262 , LS-274 , LS-271	Notice of Employee's Injury or Death , Report of Payments , Claimant's Statement , Employee's Claim for Compensation , Claim for Death Benefits , Application for Self-Insurance , Attending Physician's Supplementary Report , Report of Injury Experience of Insurance Carrier or Self-Insured Employer , Report of Earnings

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	130,036	130,036	0
Annual Time Burden (Hours)	44,955	44,950	5
Annual Cost Burden (Dollars)	46,866	45,979	887

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 hours have increased from 44,950 to 44,955 due to proposed changes to the LS-513. Burden cost have increased by $887 from $45,979 to $46,866 due to an increase in the cost of postage.

Annual Cost to Federal Government: $252,544

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Cheryl Jordan 202 693-0289 [email protected]

Common Form ICR: No