OMB control number

Request for Intervention, Longshore and Harbor Workers' Compensation Act

OMB 1240-0058 · DOL/OWCP.

OMB 1240-0058

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.

The latest form for Request for Intervention, Longshore and Harbor Workers' Compensation Act expires 2029-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form LS-9 Stipulation Approval Request Form and Instruction
Form LS-8 Settlement Approval Request Section 8(i) Form and Instruction
Form LS-7 Request for Intervention Form and Instruction
Form LS-6 Commutation Application Form and Instruction
Form LS-5 Application for Special Fund Form and Instruction
Form LS-4 Attorney Fee Order Request Form and Instruction
1240-0058 Request for Intervention LHWCA_Supporting Statement_OCIO1-ao jp jm_final.docx Supporting Statement A
PC2.pdf Public Comments
PC1.pdf Public Comments
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction
Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction

All Historical Document Collections

202511-1240-001 Approved without change	Extension without change of a currently approved collection	2026-03-06
202210-1240-001 Approved without change	Extension without change of a currently approved collection	2023-02-02
202012-1240-004	No material or nonsubstantive change to a currently approved collection	2020-12-15
201910-1240-001 Approved without change	New collection (Request for a new OMB Control Number)	2019-11-25