Information Collection

Request for Intervention, Longshore and Harbor Workers' Compensation Act

IC 237986 under ICR 202511-1240-001 · OMB 1240-0058.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Request for Intervention, Longshore and Harbor Workers' Compensation Act
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.134 20 CFR 702.301 20 CFR 702.312 20 CFR 702.142 20 CFR 702.102 20 CFR 702.321 20 CFR 702.311 20 CFR 702.242 20 CFR 702.315

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

Income Security General Retirement and Disability

DOL/OWCP-3  81 FR 25765

21,176 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,176 0 0 8,762 0 12,414
Annual IC Time Burden (Hours) 5,828 0 0 2,639 0 3,189
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.
Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].