1240-0040 Justification - Certification of Funeral Expenses (LS-265)

1240-0040 Justification - Certification of Funeral Expenses (LS-265).docx

Certification of Funeral Expenses

1240-0040 Justification - Certification of Funeral Expenses (LS-265)

OMB: 1240-0040

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1240-0040 – Certification of Funeral Expenses (LS-265)


The Division of Longshore and Harbor Workers’ Compensation administers the Longshore and Harbor Workers’ Compensation Act (LHWCA). This Act provides benefits to workers injured in maritime employment on the navigable waters of the United States or in an adjoining area customarily used by an employer in loading, unloading, repairing, or building a vessel. In addition, several acts extend Longshore Act coverage to certain other employees.

The burden hours for this information collection have remained unchanged from the previous submission but requires respondents to be registered users of the web portal to electronically upload documents into a case record. The time to input this information is minimal, less than one minute, and therefore does not impact the current burden estimates.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSuggs, Anjanette C - OWCP
File Modified0000-00-00
File Created2021-01-12

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