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Federal forms, ICRs, and supporting documents

OMB control number

Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions

OMB 1240-0005 · DOL/OWCP.

OMB 1240-0005

OWCP Forms LS-275-IC, LS-275-SI, and LS-276 cover the submission of information by insurance carriers and self-insured employers regarding their ability to meet their financial obligations under the Longshore Act and its extensions.

The latest form for Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions expires 2026-08-31 and is listed under ICR 202304-1240-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-276 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its ExtensionsForm and Instruction
Supporting Statement for 1240-0005_ OCIO 5-4.docxSupporting Statement A
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202304-1240-005 Extension without change of a currently approved collection 2023-06-28 Approved with change
202008-1240-059 No material or nonsubstantive change to a currently approved collection 2020-12-15
201910-1240-003 Reinstatement without change of a previously approved collection 2020-03-12 Approved without change
201606-1240-002 Extension without change of a currently approved collection 2016-09-16 Approved without change
201506-1240-004 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-005 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201306-1240-003 Extension without change of a currently approved collection 2013-09-24 Approved without change
201004-1240-001 Revision of a currently approved collection 2010-09-16 Approved without change
201003-1240-005 Extension without change of a currently approved collection 2010-03-12 Approved without change