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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
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
To view an IC, click on IC Title