Information Collection

Notice of Controversion of Right to Compensation

IC 13638 under ICR 201409-1240-008 · OMB 1240-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-207 Notice of Controversion of Right to Compensation	Form
LS-207 Notice of Controversion of Right to Compensation ls-207.pdf www.dol.gov/owcp/dlhwc/ls-207.pdf	Form
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document

IC Title:

Notice of Controversion of Right to Compensation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 702.251

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-207	Notice of Controversion of Right to Compensation	ls-207.pdf	http://www.dol.gov/owcp/dlhwc/ls-207.pdf	Yes	No	Fillable Printable

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: 700

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	17,500	17,500
Annual IC Time Burden (Hours)	4,375	4,375
Annual IC Cost Burden (Dollars)	9,013	9,013

Documents for IC

table that charts IC Documents
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.