Notice of Final Payment or Suspension of Compensation Benefits

ICR 200512-1215-002

OMB: 1215-0024

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1215-0024 200512-1215-002
Historical Active 200301-1215-006
DOL/ESA
Notice of Final Payment or Suspension of Compensation Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 02/27/2006
Retrieve Notice of Action (NOA) 12/13/2005
  Inventory as of this Action Requested Previously Approved
02/28/2009 02/28/2009 03/31/2006
22,722 0 18,950
5,681 0 4,738
16,000 0 11,000

Report is used by insurance carriers and self-insured employers to report the payment of benefits under the Longshore and Harbor Workers' Compensation Act.

None
None


No

1
IC Title Form No. Form Name
Notice of Final Payment or Suspension of Compensation Benefits 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 22,722 18,950 0 0 3,772 0
Annual Time Burden (Hours) 5,681 4,738 0 0 943 0
Annual Cost Burden (Dollars) 16,000 11,000 0 0 5,000 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.
12/13/2005


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