Payment of Compensation Without Award

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form LS-206 Payment of Compensation Without Award	Form	Modified	Available
DOL-ESA-15.pdf	Supplementary Document	Uploaded 2008-09-10	Available
SS 1215-0022 - July 2008[1].doc	Supporting Statement A	Uploaded 2008-09-11	Available
20CFR702.234.htm	Supplementary Document	Uploaded 2008-05-08	Available
33 USC 914(c).doc	Supplementary Document	Uploaded 2008-05-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13633	Payment of Compensation Without Award	Form	Modified

ICR Details

OMB Control No: 1215-0022	ICR Reference No: 200805-1215-005
Status: Historical Active	Previous ICR Reference No: 200509-1215-004
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Payment of Compensation Without Award
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/28/2008
	Date Received in OIRA: 09/18/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2011	36 Months From Approved	12/31/2008
Responses	21,000	0	24,500
Time Burden (Hours)	5,250	0	6,125
Cost Burden (Dollars)	10,395	0	11,000

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Abstract: The LS-206 is used by insurance carriers and self-insurers to report the initial payment of compensation benefits to injured claimants as required by the Longshore and Harbor Workers' Compensation Act.

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Authorizing Statute(s): US Code: 33 USC 914(c) Name of Law: Longshore and Harbor Workers' Compensation Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 31888	06/04/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 54170	09/18/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Payment of Compensation Without Award	LS-206	Payment of Compensation without Award

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ICR Summary of Burden

table that charts list of burden

	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	21,000	24,500	0	0	-3,500	0
Annual Time Burden (Hours)	5,250	6,125	0	0	-875	0
Annual Cost Burden (Dollars)	10,395	11,000	0	0	-605	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There has been an adjustment to the burden hours for this clearance. The burden hours has been reduced from 6,125 hours to 5,250 hours which is a reduction of -875 hours. The operation and maintenance costs have been reduced by -$605.00 (from $11,000 to $10,395.00). The reduction in burden hours is the result of reduced reporting under the Act due to a decrease in the number of authorized carriers and self-insurers (from 700 to 600, each of whom will submit an average of 35 responses) for an estimate of 21,000 responses. The change in operation and maintenance costs is reduced due to decrease in the number of responses received since the last clearance.

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Annual Cost to Federal Government: $54,650

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/18/2008

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