Information Collection

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

IC 43808 under ICR 201412-1240-006 · OMB 1240-0014.

⚠️ Notice: This information collection may be referencing outdated material.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

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Information Collection (IC) Details

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IC Title:	Regulations Governing the Administration of the 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 703.310 20 CFR 702.201 20 CFR 702.242 20 CFR 702.285 20 CFR 702.162 20 CFR 702.111 20 CFR 702.321 20 CFR 702.175 20 CFR 702.202 20 CFR 702.174 20 CFR 702.221

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/ESA-15	FR Citation: 67 FR 16886

Number of Respondents: 130,036	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	130,036	0	130,036
Annual IC Time Burden (Hours)	44,955	0	44,955
Annual IC Cost Burden (Dollars)	41,257	-5,609	46,866

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.