Information Collection

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

IC 13942 under ICR 200403-1215-004 · OMB 1215-0204.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0204 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	LS-275-SI	No	No
Form	LS-276	No	No
Form	LS-275-IC	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 685	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	728	728
Annual IC Time Burden (Hours)	470	470
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.