Administration of the Longshore and Harbor Workers' Compensation Act

ICR 202502-1240-005 · OMB 1240-0014 · Received in OIRA

Forms and Documents

Document	Type	Status	Availability
Justification for No material change to 1240-0014 (LS-201 and LS-203).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-02-19	Repair queued
Supporting Statement for 1240-0014 September 2023 CLEAN.docx	Supporting Statement A	Uploaded 2023-09-19	Repair queued

IC Document Collections

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

ICR Details

OMB Control No: 1240-0014	ICR Reference No: 202502-1240-005
Status: Received in OIRA	Previous ICR Reference No: 202307-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Administration of the Longshore and Harbor Workers' Compensation Act
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 02/19/2025

	Requested	Previously Approved
Expiration Date	11/30/2026	11/30/2026
Responses	76,417	76,417
Time Burden (Hours)	21,155	21,155
Cost Burden (Dollars)	0	0

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 944 Name of Law: Longshore and Harbor Workers' Compensation A
US Code: 33 USC 939 Name of Law: Longshore and Harbor Workers' Compensation A

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:
	88 FR 30344	05/11/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 65753	09/25/2023
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-200, LS-201, LS-203, LS-204, LS-262, LS-267, LS-272, LS-274, LS-271, LS-513	Report of Earnings , Notice of Employee's Injury or Death , Employee's Claim for Compensation , Attending Physician's Supplementary Report , Claim for Death Benefits , Claimant's Statement , Application to write Longshore Insurance , Report of Injury Experience of Insurance Carrier or Self-Insured Employer , Application for Self-Insurance , Report of Payments

ICR Summary of Burden

	Total Request	Previously Approved
Annual Number of Responses	76,417	76,417
Annual Time Burden (Hours)	21,155	21,155
Annual Cost Burden (Dollars)	0	0

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:

Annual Cost to Federal Government: $113,599

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

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? No

Agency Contact: Jamie Margherio 713 651-4658 [email protected]

Common Form ICR: No