Agreement and Undertaking

OMB 1240-0039

The OWCP-1 is a form completed by employers to provide the Secretary of Labor with authorization to sell securities or to bring suit under indemnity bonds deposited by the self-insured employers in the event there is a default in the payment of benefits.

The latest form for Agreement and Undertaking expires 2021-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form OWCP-1 Agreement and Undertaking Form
30-day FRN (1240-0039) published.pdf Supplementary Document
30 USC 901.pdf Supplementary Document
20 CFR Part 726.110.pdf Supplementary Document
30 USC 933.pdf Supplementary Document
60-day FRN (1240-0039) published.pdf Supplementary Document
1240-0039 Supporting Statement A (01042021).docx Supporting Statement A
Agreement and Undertaking Form

All Historical Document Collections

202012-1240-005 Approved without change	Extension without change of a currently approved collection	2021-03-15
201708-1240-001 Approved without change	Extension without change of a currently approved collection	2018-02-01
201407-1240-002 Approved without change	Extension without change of a currently approved collection	2014-10-21
201108-1240-002 Approved without change	Revision of a currently approved collection	2011-10-31
201003-1240-039 Approved without change	Revision of a currently approved collection	2010-03-12