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 130036 44955 46866 Form LS-201 Notice of Employee's Injury or Death
Form LS-513 Report of Payments
Form LS-267 Claimant's Statement
Form LS-203 Employee's Claim for Compensation
Form LS-262 Claim for Death Benefits
Other-Recordkeeping
Form LS-271 Application for Self-Insurance
Form LS-204 Attending Physician's Supplementary Report
Form LS-274 Report of Injury Experience of Insurance Carrier or Self-Insured Employer
Form LS-200 Report of Earnings
Total burden requested under this ICR: 130036 44955 46866  
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