Information Collection

Notice of Final Payment or Suspension of Compensation Benefits

IC 13642 under ICR 200807-1215-001 · OMB 1215-0024.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-208 proposed Notice of Final Payment or Suspension of Compensation Benefits	Form
LS-208 proposed Notice of Final Payment or Suspension of Compensation Be ls-208 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-208.pdf	Form
ls-208 current.pdf Notice of Final Payment or Suspension of Compensation Benefits	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 702.236 20 CFR 702.235

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-208 proposed	Notice of Final Payment or Suspension of Compensation Benefits	ls-208 proposed.pdf	http://www.dol.gov/esa/owcp/dlhwc/ls-208.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/ESA-15

FR Citation: 58 FR 49599

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: 1 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,000	-7,722	22,722
Annual IC Time Burden (Hours)	3,750	-1,931	5,681
Annual IC Cost Burden (Dollars)	11,550	-4,450	16,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Notice of Final Payment or Suspension of Compensation Benefits	ls-208 current.pdf	11/17/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.