Information Collection

Notice of Final Payment or Suspension of Compensation Benefits

IC 13641 under ICR 200301-1215-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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	18,950	-400	19,350
Annual IC Time Burden (Hours)	4,738	-100	4,838
Annual IC Cost Burden (Dollars)	11,000	1,000	10,000

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.