Notice of Final Payment or Suspension of Compensation Benefits

Notice of Final Payment or Suspension of Compensation Benefits

OMB: 1240-0041

IC ID: 13642

Information Collection (IC) Details

View Information Collection (IC)

Notice of Final Payment or Suspension of Compensation Benefits
 
No Modified
 
Mandatory
 
20 CFR 702.236 20 CFR 702.235

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

Income Security General Retirement and Disability

DOL/ESA-15  67 FR 16886

600 0
   
Private Sector Businesses or other for-profits
 
   1 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 21,000 0 0 6,000 0 15,000
Annual IC Time Burden (Hours) 5,250 0 0 1,500 0 3,750
Annual IC Cost Burden (Dollars) 16,590 0 0 5,040 0 11,550

Title Document Date Uploaded
Notice of Final Payment or Suspension of Compensation Benefits ls-208 Revised.pdf 01/04/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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