Notice to Reviewer

OMB No. 1240-0005

Application for Security Deposit Determination (LS-276)

Agreement and Undertaking (Insurance Carrier) (LS-275ic)

Agreement and Undertaking (Self-Insured Employer) (LS275si)

Notice to OMB Reviewer:

The Office of Workers’ Compensation Programs (OWCP) Division of Longshore and Harbor Workers’ Compensation (DLHWC) is requesting this non-material change in conjunction with the publication of a Direct Final Rule (the Transmission of Documents and Information Rule) in January 2015.

The Transmission of Documents and Information Rule does not change what is collected in this information collection request (ICR), but does change the manner in which forms that collect information may be submitted. Instead of mandating the transmission of information by postal mail, it allows OWCP and private parties to use electronic and other commonly used communication methods. It also provides flexibility for OWCP to allow submission of information using future technologies. Although the rule does not eliminate any current methods of submission for this collection, because its allowance of electronic submission will result in mailing cost savings (envelopes and postage), the OWCP anticipates some savings for the public.

Initially, the anticipated use of electronic means of transmission is estimated to be 13%. In the future, as electronic transmission submission options increase and are used more frequently, this percentage will likely increase. When this collection comes up for renewal in the future, a more precise percentage can be used and the burden estimate adjusted accordingly.

• Mailing costs were previously estimated at $327.08.

• Anticipating a 13% rate of electronic transmission and an accompanying reduction in postal mail transmission, the DOL estimates this rule would yield a savings for this collection of $42.52.

• Revised mailing costs are estimated to be $284.56.