OMB control number
Agreement and Undertaking
OMB 1240-0039 ยท DOL/OWCP.
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 2027-06-30 and is listed under ICR 202401-1240-001.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form OWCP-1 Agreement and Undertaking | Form |
 Supporting Statement OWCP-1- Final.docx | Supporting Statement A |
| 30-day FRN (1240-0039) published.pdf | Supplementary Document |
| 30 USC 901.pdf | Supplementary Document |
| 20 CFR Part 726.110.pdf (document unavailable) | Supplementary Document |
| 30 USC 933.pdf | Supplementary Document |
| 60-day FRN (1240-0039) published.pdf | Supplementary Document |
 Agreement and Undertaking |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202401-1240-001 | Extension without change of a currently approved collection | 2024-05-20 | Approved with change | |
| 202012-1240-005 | Extension without change of a currently approved collection | 2021-03-15 | Approved without change | |
| 201708-1240-001 | Extension without change of a currently approved collection | 2018-02-01 | Approved without change | |
| 201407-1240-002 | Extension without change of a currently approved collection | 2014-10-21 | Approved without change | |
| 201108-1240-002 | Revision of a currently approved collection | 2011-10-31 | Approved without change | |
| 201003-1240-039 | Revision of a currently approved collection | 2010-03-12 | Approved without change |