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 76417 21155 0 Other-Recordkeeping
Instruction
Instruction
Form and Instruction LS-200 Report of Earnings
Form and Instruction LS-201 Notice of Employee's Injury or Death
Form and Instruction LS-203 Employee's Claim for Compensation
Form and Instruction LS-204 Attending Physician's Supplementary Report
Form and Instruction LS-262 Claim for Death Benefits
Form and Instruction LS-267 Claimant's Statement
Form and Instruction LS-272 Application to write Longshore Insurance
Form and Instruction LS-274 Report of Injury Experience of Insurance Carrier or Self-Insured Employer
Form and Instruction LS-271 Application for Self-Insurance
Form and Instruction LS-513 Report of Payments
Total burden requested under this ICR: 76417 21155 0  
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