Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions

ICR 200403-1215-004

OMB: 1215-0204

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1215-0204 200403-1215-004
Historical Active
DOL/ESA
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/22/2004
Retrieve Notice of Action (NOA) 03/12/2004
Upon resubmission of this PRA in 2007, DOL will report on the viability of developing criteria to exempt financially secure carriers from making a deposit of security as required under this collection.
  Inventory as of this Action Requested Previously Approved
06/30/2007 06/30/2007
728 0 0
470 0 0
0 0 0

These forms 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.

None
None


No

1
IC Title Form No. Form Name
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions LS-275-IC, LS-275-SI, LS-276

  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 728 0 0 728 0 0
Annual Time Burden (Hours) 470 0 0 470 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
03/12/2004


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