OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Carrier's Report of Issuance of Policy

OMB 1240-0004 · DOL/OWCP.

OMB 1240-0004

The Carrier's Report of Issuance of Policy (Form LS-570) is used by authorized insurance carriers to report the policy of insurance issued for each insured employer. This form is to be sent to the Deputy Commissioner in the compensation district indicated by the employer's address. Section 32(a) of the Longshore and Harbor Workers’ Compensation Act (33 USC 932(a)), requires every employer to secure the payment of such compensation with any insurance company authorized by the Secretary, to insure payment of compensation under this Act or receiving authorization from the Secretary to pay such compensation directly.

The latest form for Carrier's Report of Issuance of Policy expires 2028-08-31 and is listed under ICR 202506-1240-002.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-570 Carrier's Report of Issuance of PolicyForm
Form LS-570 Carrier's Report of Issuance of PolicyForm
OMB - Supporting Statement for 1240-0004 (LS570) 8-31-2025 - OCIO1.docxSupporting Statement A
OMB - Supporting Statement for 1240-0004 (LS570) 8-31-2025 - OCIO1.docxSupporting Statement A
WCPO-2025-0004-DRAFT-0002_Comment_Anonymous.html (document unavailable)Public Comments
Carrier's Report of Issuance of Policy Form
Carrier's Report of Issuance of Policy Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202506-1240-002 Extension without change of a currently approved collection 2025-07-15
202201-1240-001 Extension without change of a currently approved collection 2022-06-10 Approved without change
202008-1240-052 No material or nonsubstantive change to a currently approved collection 2020-12-15
201902-1240-003 Extension without change of a currently approved collection 2019-05-31 Approved without change
201507-1240-008 Extension without change of a currently approved collection 2016-01-29 Approved without change
201506-1240-003 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-004 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201209-1240-003 Revision of a currently approved collection 2012-12-11 Approved without change
201003-1240-004 Existing collection in use without an OMB Control Number 2010-03-12 Approved without change