Information Collection Request

Request for Intervention, Longshore and Harbor Workers' Compensation Act

ICR 202511-1240-001 · OMB 1240-0058 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form LS-9 Stipulation Approval Request Form and Instruction Modified Available
Form LS-8 Settlement Approval Request Section 8(i) Form and Instruction Modified Available
Form LS-7 Request for Intervention Form and Instruction Modified Available
Form LS-6 Commutation Application Form and Instruction Modified Available
Form LS-5 Application for Special Fund Form and Instruction Modified Available
Form LS-4 Attorney Fee Order Request Form and Instruction Modified Available
1240-0058 Request for Intervention LHWCA_Supporting Statement_OCIO1-ao jp jm_final.docx Supporting Statement A Uploaded 2026-03-02 Available
PC2.pdf Public Comments Uploaded 2026-02-08 Available
PC1.pdf Public Comments Uploaded 2026-02-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedStipulation Approval Request
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedSettlement Approval Request Section 8(i)
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedRequest for Intervention
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedCommutation Application
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedApplication for Special Fund
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction ModifiedAttorney Fee Order Request
237986 Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction Modified
ICR Details
1240-0058 202511-1240-001
Active 202210-1240-001
DOL/OWCP
Request for Intervention, Longshore and Harbor Workers' Compensation Act
Extension without change of a currently approved collection   No
Regular
Approved without change 04/10/2026
Retrieve Notice of Action (NOA) 03/06/2026
  Inventory as of this Action Requested Previously Approved
04/30/2029 36 Months From Approved 04/30/2026
21,176 0 12,414
5,828 0 3,189
0 0 0

The Office of Workers' Compensation Programs administers the Longshore and Harbor Workers' Compensation Act which, through these collections, provides benefits to workers injured in maritime employment on the navigable waters of the United States or in an adjoining area customarily used by an employer in loading, unloading, repairing, or building a vessel.

US Code: 33 USC 939 Name of Law: Longshore and Harbor Workers' Compensation Act
  
None

Not associated with rulemaking

  90 FR 57486 12/11/2025
91 FR 11087 03/06/2026
Yes

  Total Approved 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 21,176 12,414 0 0 8,762 0
Annual Time Burden (Hours) 5,828 3,189 0 0 2,639 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The number of respondents and responses both increased from 12,414 to 21,176 due to the increase in the number of forms received. The increase in number of respondents therefore resultingly increased the number of burden hours from 3,189 to 5,828. Costs to respondents remained the same at 0.

$22,177
No
    Yes
    Yes
No
No
No
No
Anjanette Suggs 202 354-9660 [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.
03/06/2026