OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request for Earnings Information Report

OMB 1240-0025 ยท DOL/OWCP.

OMB 1240-0025

The Request for Earnings Information Report gathers information regarding an employee's average weekly wage. This information is needed for determination of compensation benefits in accordance with Section 10 of the Longshore and Harbor Workers' Compensation Act.

The latest form for Request for Earnings Information Report expires 2028-02-29 and is listed under ICR 202409-1240-004.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-426 Report for Earnings InformationForm and Instruction
Form LS-426 Request for Earnings InformationForm and Instruction
2024-23728 Federal Register Oct15 2024 89 FR 83054.pdfSupplementary Document
2024-23728 Federal Register Oct15 2024 89 FR 83054.pdf Supplementary Document
1240-0025 Supporting Statement (LS-426) 12-24 ROCIS.docxSupporting Statement A
1240-0025 Supporting Statement (LS-426) 12-24 ROCIS.docxSupporting Statement A
33 USC 910.docSupplementary Document
33 USC 910.doc Supplementary Document
33 USC 908.docSupplementary Document
33 USC 908.doc Supplementary Document
Request for Earnings Information Form and Instruction
Request for Earnings Information Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202409-1240-004 Extension without change of a currently approved collection 2024-12-30
202106-1240-001 Extension without change of a currently approved collection 2021-12-10 Approved without change
202008-1240-065 No material or nonsubstantive change to a currently approved collection 2020-12-15
201807-1240-001 Extension without change of a currently approved collection 2018-10-01 Approved without change
201506-1240-013 Extension without change of a currently approved collection 2015-07-28 Approved without change
201506-1240-002 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-007 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201409-1240-012 No material or nonsubstantive change to a currently approved collection 2014-09-30 Approved without change
201205-1240-002 Revision of a currently approved collection 2012-06-21 Approved without change
201003-1240-025 Extension without change of a currently approved collection 2010-03-12 Approved without change