OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201412-1240-005 · OMB 1240-0005 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
13942 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Modified
ICR Details
1240-0005 201412-1240-005
Historical Inactive 201306-1240-003
DOL/OWCP
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
No material or nonsubstantive change to a currently approved collection   No
Regular
Preapproved 05/15/2015
Retrieve Notice of Action (NOA) 03/12/2015
  Inventory as of this Action Requested Previously Approved
10/31/2016 10/31/2016 10/31/2016
668 0 668
454 0 454
301 0 344
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
Proposed rulemaking
  78 FR 35326 06/12/2013
78 FR 58566 09/24/2013
No
1
IC Title Form No. Form Name
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions LS-276, LS-275(SI), LS-275(IC)
  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 668 668 0 0 0 0
Annual Time Burden (Hours) 454 454 0 0 0 0
Annual Cost Burden (Dollars) 301 344 0 -43 0 0
No
No
$15,659
No
No
No
No
No
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.
03/12/2015