Notice of Final Payment or Suspension of Compensation Benefits

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form LS-208 proposed Notice of Final Payment or Suspension of Compensation Benefits	Form	Modified	Available
OMB - 1215-0024 - LS-208 Supporting Statement - 11-2008.doc	Supporting Statement A	Uploaded 2008-11-25	Available
20CFR702_702_236 - Penalty for failure to report termination of payments.htm	Supplementary Document	Uploaded 2008-07-22	Repair queued
20CFR702_702_235 - Report by employer of final payment of compensation.htm	Supplementary Document	Uploaded 2008-07-22	Available
33 USC 914(g).doc	Supplementary Document	Uploaded 2008-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13642	Notice of Final Payment or Suspension of Compensation Benefits	Form	Modified

ICR Details

OMB Control No: 1215-0024	ICR Reference No: 200807-1215-001
Status: Historical Active	Previous ICR Reference No: 200512-1215-002
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Notice of Final Payment or Suspension of Compensation Benefits
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: 01/08/2009
	Date Received in OIRA: 12/02/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved	02/28/2009
Responses	15,000	0	22,722
Time Burden (Hours)	3,750	0	5,681
Cost Burden (Dollars)	11,550	0	16,000

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

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Authorizing Statute(s): US Code: 33 USC 914(g) 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 45790	08/06/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 73349	12/02/2008
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
Notice of Final Payment or Suspension of Compensation Benefits	LS-208 proposed	Notice of Final Payment or Suspension of Compensation Benefits

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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	15,000	22,722	0	0	-7,722	0
Annual Time Burden (Hours)	3,750	5,681	0	0	-1,931	0
Annual Cost Burden (Dollars)	11,550	16,000	0	0	-4,450	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: The burden hours for this information collection have decreased from the previous submission of 5,681 to 3,750, which is an adjustment of -1,931 burden hours. Improved technology allows us to obtain the actual number of forms received each year from the LongShore Case Management System database and allows for the completion of the form electronically. The reduction in the number of forms received is also due to reduced reporting under the Act.

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Annual Cost to Federal Government: $43,334

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: 12/02/2008

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