Information Collection

Notice of Final Payment or Suspension of Compensation Benefits

IC 13639 under ICR 199705-1215-002 · OMB 1215-0024.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0024 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Notice of Final Payment or Suspension of Compensation Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-208				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	28,000	0	28,000
Annual IC Time Burden (Hours)	7,000	0	7,000
Annual IC Cost Burden (Dollars)	14,000	14,000	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.