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Federal forms, ICRs, and supporting documents

OMB control number

Certification of Funeral Expenses under the Longshore and Harbor Workers' Compensation Act

OMB 1240-0040 · DOL/OWCP.

OMB 1240-0040

Form LS-265 is used to report funeral expenses payable under the Longshore and Harbor Workers' Compensation Act.

The latest form for Certification of Funeral Expenses under the Longshore and Harbor Workers' Compensation Act expires 2026-11-30 and is listed under ICR 202309-1240-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form LS-265 Certification of Funeral ExpensesForm
Supporting Statement for 1240-0040 10-2023_MNclean.docxSupporting Statement A
2023 60-Day FRN_1240-0040.pdf Supplementary Document
PRIVACY ACT SYSTEMS - EFF. 2019.docx Supplementary Document
20CFR702.121.mht Supplementary Document
33 USC section 909.doc Supplementary Document
Certification of Funeral Expenses Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202309-1240-005 Revision of a currently approved collection 2023-10-17 Approved without change
202012-1240-003 No material or nonsubstantive change to a currently approved collection 2020-12-15
202003-1240-007 Extension without change of a currently approved collection 2020-08-11 Approved without change
201703-1240-003 Extension without change of a currently approved collection 2017-05-18 Approved without change
201506-1240-008 Revision of a currently approved collection 2015-06-05 Approved without change
201412-1240-011 No material or nonsubstantive change to a currently approved collection 2015-03-12 Preapproved
201409-1240-010 No material or nonsubstantive change to a currently approved collection 2014-09-30 Approved without change
201312-1240-002 Extension without change of a currently approved collection 2014-04-10 Approved without change
201102-1240-001 Extension without change of a currently approved collection 2011-02-28 Approved without change
201003-1240-040 Extension without change of a currently approved collection 2010-03-12 Approved without change