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 202008-1240-059 · OMB 1240-0005 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form LS-276 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form Modified Repair queued
1240-0005 - Justification for No materialNonsubstantive Change.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-10-02 Repair queued
OMB - Supporting Statement for 1240-0005 2019.docx Supporting Statement A Uploaded 2020-09-09 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
13942 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form Modified
ICR Details
1240-0005 202008-1240-059
Received in OIRA 201910-1240-003
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 12/15/2020
  Requested Previously Approved
07/31/2023 07/31/2023
695 695
869 869
12 16,152
Forms LS-275-IC, LS-275-SI and LS-276 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
  84 FR 59646 11/05/2019
85 FR 13933 03/10/2020
No
  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 695 695 0 0 0 0
Annual Time Burden (Hours) 869 869 0 0 0 0
Annual Cost Burden (Dollars) 12 16,152 0 -16,140 0 0
No
No
$18,251
No
    No
    No
No
No
No
No
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.
12/15/2020