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Agenda
Reg Review
ICR
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
To view an IC, click on IC Title