Information Collection

Request for Intervention, Longshore and Harbor Workers' Compensation Act

IC 237986 under ICR 202210-1240-001 · OMB 1240-0058.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0058 can be found here:

2026-03-06 - Extension without change of a currently approved collection

Documents and Forms

Document Name Document Type
Form LS-4 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
LS-4 Attorney Fee Approval Request ls-4 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4_static.pdf Form and Instruction
LS-4 Attorney Fee Approval Request ls-4 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4_static.pdf Form and Instruction
LS-5 Application for Special Fund Relief ls-5 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5_static.pdf Form and Instruction
LS-5 Application for Special Fund Relief ls-5 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5_static.pdf Form and Instruction
LS-6 Commutation Application ls-6 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6_static.pdf Form and Instruction
LS-6 Commutation Application ls-6 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6_static.pdf Form and Instruction
LS-7 Request for Intervention ls-7 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7_static.pdf Form and Instruction
LS-7 Request for Intervention ls-7 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7_static.pdf Form and Instruction
LS-8 Settlement Approval Request Section 8(i) ls-8 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8_static.pdf Form and Instruction
LS-8 Settlement Approval Request Section 8(i) ls-8 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8_static.pdf Form and Instruction
LS-9 Stipulation Approval Request ls-9 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9_static.pdf Form and Instruction
LS-9 Stipulation Approval Request ls-9 static.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9_static.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Intervention, 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 702.315 20 CFR 702.311 20 CFR 702.301 20 CFR 702.134 20 CFR 702.312 20 CFR 702.142 20 CFR 702.102 20 CFR 702.321 20 CFR 702.242

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	LS-4	Attorney Fee Approval Request	ls-4 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4_static.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-5	Application for Special Fund Relief	ls-5 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5_static.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-6	Commutation Application	ls-6 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6_static.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-7	Request for Intervention	ls-7 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7_static.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-8	Settlement Approval Request Section 8(i)	ls-8 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8_static.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-9	Stipulation Approval Request	ls-9 static.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9_static.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/OWCP-3	FR Citation: 81 FR 25765

Number of Respondents: 12,414	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,414	0	12,414
Annual IC Time Burden (Hours)	3,189	0	3,189
Annual IC Cost Burden (Dollars)	0	-343	343

Documents for IC

Title	Document	Date Uploaded
No associated records found

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