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

OMB 1240-0005

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 2023-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form LS-276 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form and Instruction
Supporting Statement for 1240-0005_ OCIO 5-4.docx Supporting Statement A
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form and Instruction

All Historical Document Collections

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