OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Administration of the Longshore and Harbor Workers' Compensation Act

OMB 1240-0014 · DOL/OWCP.

OMB 1240-0014

The regulations and forms cover the submission of information relating to the processing of claims for benefits under the Longshore Act and extensions.

The latest form for Administration of the Longshore and Harbor Workers' Compensation Act expires 2026-11-30 and is listed under ICR 202502-1240-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-513 Report of PaymentsForm and Instruction
Form LS-271 Application for Self-InsuranceForm and Instruction
Form LS-274 Report of Injury Experience of Insurance Carrier or Self-Insured EmployerForm and Instruction
Form LS-272 Application to write Longshore InsuranceForm and Instruction
Form LS-267 Claimant's StatementForm and Instruction
Form LS-262 Claim for Death BenefitsForm and Instruction
Form LS-204 Attending Physician's Supplementary ReportForm and Instruction
Form LS-203 Employee's Claim for CompensationForm and Instruction
Form LS-201 Notice of Employee's Injury or DeathForm and Instruction
Form LS-200 Report of EarningsForm and Instruction
Justification for No material change to 1240-0014 (LS-201 and LS-203) 2025.docxJustification for No Material/Nonsubstantive Change
Supporting Statement for 1240-0014 September 2023 CLEAN.docxSupporting Statement A
Supporting Statement for 1240-0014 September 2023 CLEAN.docxSupporting Statement A
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form and Instruction
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Other-Recordkeeping

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202502-1240-005 No material or nonsubstantive change to a currently approved collection 2025-02-19
202307-1240-001 Revision of a currently approved collection 2023-09-25 Approved without change
202012-1240-001 No material or nonsubstantive change to a currently approved collection 2020-12-15
202001-1240-002 Revision of a currently approved collection 2020-05-27 Approved without change
201803-1240-005 No material or nonsubstantive change to a currently approved collection 2018-04-24 Approved without change
201612-1240-009 Extension without change of a currently approved collection 2017-01-31 Approved without change
201509-1240-001 No material or nonsubstantive change to a currently approved collection 2015-10-19 Approved without change
201506-1240-005 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-006 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201409-1240-003 No material or nonsubstantive change to a currently approved collection 2014-09-30 Approved without change
201407-1240-001 No material or nonsubstantive change to a currently approved collection 2014-07-03 Approved without change
201309-1240-005 Revision of a currently approved collection 2013-12-27 Approved without change
201202-1240-003 Revision of a currently approved collection 2012-06-29 Approved without change
201003-1240-014 Extension without change of a currently approved collection 2010-03-12 Approved without change