Worksheet for OMB No. 1240-0014 Nov 2013

WORKSHEET FOR OMB NO 1240-0014 Nov 2013.docx

Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act

Worksheet for OMB No. 1240-0014 Nov 2013

OMB: 1240-0014

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ITEM 15 WORKSHEET FOR OMB NO. 1240-0014 (September 2013)




REG. NO.


FORM NO./ PROGRAM


REASON



PREVIOUS BURDEN

2009


Previous BURDEN

2012


New Burden

2013


DIFFERENCE

TYPE OF CHANGE (PC/ADJ)


0

ESA-100



840

840

840

0


0

LS-200


2,448

1,904

1,904

0



LS-201


1,150

910

910

0



LS-203


2,588

2,048

2,048

0



LS-204


46,000

27,300

27,300

0



LS-262


70

70

70

0



LS-267


48

37

37

0



LS-271


40

60

60

0



LS-274


563

565

565

0



LS-513


282

283

288

5

ADJ


Liens (702.162)


5

5

5

0



Certifications (702.174)


4

4

4

0



Reinstatement (702.175)


1

1

1

0



Settlements & Applications (702.242)


10,080

9,498

9,498

0



Payments (702.321)


2,425

1,425

1,425

0



TOTAL




66,544


44,950


44,955



5


ADJ

PC – Program Change

ADJ - Adjustment

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleCHANGE WORKSHEET FOR OMB NO
AuthorUS Department of Labor
File Modified0000-00-00
File Created2021-01-23

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