NOTICE OF FINAL PAYMENT OR SUSPENSION OF COMPENSATION PAYMENTS

ICR 198303-1215-006

OMB: 1215-0024

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1215-0024 198303-1215-006
Historical Active 197803-1215-004
DOL/ESA
NOTICE OF FINAL PAYMENT OR SUSPENSION OF COMPENSATION PAYMENTS
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/21/1983
Retrieve Notice of Action (NOA) 03/07/1983
  Inventory as of this Action Requested Previously Approved
02/28/1986 02/28/1986
45,000 0 0
11,250 0 0
0 0 0

FORM IS USED BY INSURANCE CARRIERS AND SELF-INSURED EMPLOYERS TO REPORT THE PAYMENT OF BENEFITS UNDER THE ACT.

None
None


No

1
IC Title Form No. Form Name
NOTICE OF FINAL PAYMENT OR SUSPENSION OF COMPENSATION PAYMENTS LS-208

  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 45,000 0 0 0 45,000 0
Annual Time Burden (Hours) 11,250 0 0 0 11,250 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.
03/07/1983


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