REPORT OF PAYMENTS

ICR 197809-1215-003

OMB: 1215-0068

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
122046 Migrated
ICR Details
1215-0068 197809-1215-003
Historical Active
DOL/ESA
REPORT OF PAYMENTS
Revision of a currently approved collection   No
Regular
Approved without change 10/06/1978
Retrieve Notice of Action (NOA) 09/29/1978
  Inventory as of this Action Requested Previously Approved
09/30/1983 09/30/1983
550 0 0
275 0 0
0 0 0

REPORT IS USED BY EMPLOYERS AUTHORIZED TO SELF-INSURE OR INSURANCE COMPANIES TO PROVIDE AN ANNNUAL REPORT OF ALL COMPENSATION BENEFITS PAID BY THEM DURING THE CALENDAR YEAR. THIS REPORT IS SUBMITTED TO THE OWCP (20 CFR 702-148).

None
None


No

1
IC Title Form No. Form Name
REPORT OF PAYMENTS LS-513

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 550 0 0 0 550 0
Annual Time Burden (Hours) 275 0 0 0 275 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/29/1978


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