OMB control number
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
OMB 1240-0005 · DOL/OWCP.
OMB 1240-0005
OWCP 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.
The latest form for Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions expires 2026-08-31 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
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Form and Instruction |
Supporting Statement A |
Form LS-276 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
Supporting Statement for 1240-0005_ OCIO 5-4.docx
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions All Historical Document Collections
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Approved with change |
Extension without change of a currently approved collection | 2023-06-28 | |
| No material or nonsubstantive change to a currently approved collection | 2020-12-15 | ||
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Approved without change |
Reinstatement without change of a previously approved collection | 2020-03-12 | |
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Approved without change |
Extension without change of a currently approved collection | 2016-09-16 | |
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Approved without change |
Revision of a currently approved collection | 2015-06-05 | |
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Preapproved |
No material or nonsubstantive change to a currently approved collection | 2015-03-12 | |
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Approved without change |
Extension without change of a currently approved collection | 2013-09-24 | |
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Approved without change |
Revision of a currently approved collection | 2010-09-16 | |
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Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |