Notice of Final Payment or Suspension of Compensation Benefits

ICR 201411-1240-003

OMB: 1240-0041

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
1240-0041 201411-1240-003
Historical Active 201409-1240-009
DOL/OWCP
Notice of Final Payment or Suspension of Compensation Benefits
Revision of a currently approved collection   No
Regular
Approved without change 05/20/2015
Retrieve Notice of Action (NOA) 02/27/2015
  Inventory as of this Action Requested Previously Approved
05/31/2018 36 Months From Approved 05/31/2015
21,000 0 21,000
5,250 0 5,250
9,500 0 16,590

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

  79 FR 71130 12/01/2014
80 FR 10720 02/27/2015
No

1
IC Title Form No. Form Name
Notice of Final Payment or Suspension of Compensation Benefits LS-208 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 21,000 21,000 0 0 0 0
Annual Time Burden (Hours) 5,250 5,250 0 0 0 0
Annual Cost Burden (Dollars) 9,500 16,590 0 -7,090 0 0
No
No

$63,403
No
No
No
No
No
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.
02/27/2015


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