Notice of Final Payment or Suspension of Compensation Benefits

ICR 200807-1215-001

OMB: 1215-0024

Federal Form Document

IC Document Collections
ICR Details
1215-0024 200807-1215-001
Historical Active 200512-1215-002
DOL/ESA
Notice of Final Payment or Suspension of Compensation Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 01/08/2009
Retrieve Notice of Action (NOA) 12/02/2008
  Inventory as of this Action Requested Previously Approved
01/31/2012 36 Months From Approved 02/28/2009
15,000 0 22,722
3,750 0 5,681
11,550 0 16,000

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

US Code: 33 USC 914(g) Name of Law: Longshore and Harbor Workers' Compensation Act
  
None

Not associated with rulemaking

  73 FR 45790 08/06/2008
73 FR 73349 12/02/2008
No

1
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

  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
No
No
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.

$43,334
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Cheryl Jordan 202 693-0289 [email protected]

  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.
12/02/2008


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