Information Collection

Request for Intervention, Longshore and Harbor Workers' Compensation Act

IC 237986 under ICR 202511-1240-001 · OMB 1240-0058.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-4 Attorney Fee Order Request Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
Form LS-5 Application for Special Fund Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
Form LS-6 Commutation Application Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
Form LS-7 Request for Intervention Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
Form LS-8 Settlement Approval Request Section 8(i) Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
Form LS-9 Stipulation Approval Request Request for Intervention, Longshore and Harbor Workers' Compensation Act	Form and Instruction
LS-4 Attorney Fee Order Request Attorney Fee Approval Request.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf	Form and Instruction
LS-5 Application for Special Fund Application for Special Fund Relief.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf	Form and Instruction
LS-6 Commutation Application Commutation Application.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf	Form and Instruction
LS-7 Request for Intervention Request for Intervention.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf	Form and Instruction
LS-8 Settlement Approval Request Section 8(i) Settlement Approval Request Section 8(i).pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf	Form and Instruction
LS-9 Stipulation Approval Request Stipulation Approval Request.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Request for Intervention, Longshore and Harbor Workers' Compensation Act

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	LS-4	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-5	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-6	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-7	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-8	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	LS-9	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/OWCP-3

FR Citation: 81 FR 25765

Number of Respondents: 21,176

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	21,176	8,762	12,414
Annual IC Time Burden (Hours)	5,828	2,639	3,189
Annual IC Cost Burden (Dollars)	0	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.

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