Information Collection

Request for Intervention, Longshore and Harbor Workers' Compensation Act

IC 237986 under ICR 201910-1240-001 · OMB 1240-0058.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0058 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-4 Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
LS-4 Attorney Fee Approval Request LS-4 Attorney Fee Approval Request.pdf	Form and Instruction
LS-5 Aplication for Special Fund Relief LS-5 Application for Special Fund Relief.pdf	Form and Instruction
LS-7 Request for Intervention LS-7 Intervention Request.pdf	Form and Instruction
LS-8 Settlement Approval Request Section 8(i) LS-8 Settlement Approval Request 8(i).pdf	Form and Instruction
LS-9 Stipulation Approval Request LS-9 Stipulation Approval Request.pdf	Form and Instruction
LS-6 LS-6 Commutation Application LS-6 Commutation Application.pdf	Form and Instruction

IC Title:

Request for Intervention, Longshore and Harbor Workers' Compensation Act

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 702.102 20 CFR 702.321 20 CFR 702.312 20 CFR 702.142 20 CFR 702.242 20 CFR 702.301 20 CFR 702.311 20 CFR 702.315 20 CFR 702.134

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	LS-4	Attorney Fee Approval Request	LS-4 Attorney Fee Approval Request.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-5	Aplication for Special Fund Relief	LS-5 Application for Special Fund Relief.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-7	Request for Intervention	LS-7 Intervention Request.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-8	Settlement Approval Request Section 8(i)	LS-8 Settlement Approval Request 8(i).pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-9	Stipulation Approval Request	LS-9 Stipulation Approval Request.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-6	LS-6 Commutation Application	LS-6 Commutation Application.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/OWCP-3, DOL/OWCP-4

FR Citation: 81 FR 25765

Number of Respondents: 12,414

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 70 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,414	12,414
Annual IC Time Burden (Hours)	3,191	3,191
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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