Payment of Compensation Without Award

Payment of Compensation Without Award

OMB: 1240-0043

IC ID: 13633

Information Collection (IC) Details

View Information Collection (IC)

Payment of Compensation Without Award
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.234

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form LS-206 Payment of Compensation without Award ls-206 proposed.pdf http://www.dol.gov/owcp/dlhwc/ls-206.pdf Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/GOVT-15  67 FR 16870

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 16,800 0 0 0 0 16,800
Annual IC Time Burden (Hours) 4,200 0 0 0 0 4,200
Annual IC Cost Burden (Dollars) 8,736 0 0 84 0 8,652

Title Document Date Uploaded
DLHWC SEA Portal DLHWC Seaportal.pdf 09/24/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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