Request for Intervention, Longshore and Harbor Workers' Compensation Act

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
237986	Request for Intervention, Longshore and Harbor Workers' Compensation Act Form and Instruction	Modified

ICR Details

OMB Control No: 1240-0058	ICR Reference No: 202511-1240-001
Status: Received in OIRA	Previous ICR Reference No: 202210-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Request for Intervention, Longshore and Harbor Workers' Compensation Act
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/06/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	03/31/2026
Responses	21,176	12,414
Time Burden (Hours)	5,828	3,189
Cost Burden (Dollars)	0	0

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Abstract: The Office of Workers' Compensation Programs administers the Longshore and Harbor Workers' Compensation Act which, through these collections, 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.

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Authorizing Statute(s): US Code: 33 USC 939 Name of Law: Longshore and Harbor Workers' Compensation Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 57486	12/11/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 11087	03/06/2026
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Intervention, Longshore and Harbor Workers' Compensation Act	LS-6, LS-8, LS-9, LS-4, LS-7, LS-5	Attorney Fee Order Request ,   Application for Special Fund ,   Commutation Application ,   Request for Intervention ,   Settlement Approval Request Section 8(i) ,   Stipulation Approval Request

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	21,176	12,414	0	0	8,762	0
Annual Time Burden (Hours)	5,828	3,189	0	0	2,639	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The number of respondents and responses both increased from 12,414 to 21,176 due to the increase in the number of forms received. The increase in number of respondents therefore resultingly increased the number of burden hours from 3,189 to 5,828. Costs to respondents remained the same at 0.

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Annual Cost to Federal Government: $22,177

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/06/2026

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