Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Modified 175374 66544 66587 Form LS-201 proposed Notice of Employee's Injury or Death
Form LS-513 proposed Report of Payments
Form LS-267 proposed Claimant's Statement
Form LS-203 proposed Employee's Claim for Compensation
Form LS-262 proposed Claim for Death Benefits
Other-Recordkeeping
Form LS-271 proposed Application for Self-Insurance
Form LS-204 proposed Attending Physician's Supplementary Report
Form LS-274 proposed Report of Injury Experience of Insurance Carrier or Self-Insured Employer
Form LS-200 proposed Report of Earnings
Total burden requested under this ICR: 175374 66544 66587  
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