Notice of Final Payment or Suspension of Compensation Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0041 can be found here:

Documents and Forms

Document Name Document Type
Form LS-208 Notice of Final Payment or Suspension of Compensation Benefits Form
LS-208 Notice of Final Payment or Suspension of Compensation Be ls-208 proposed.pdf www.dol.gov/owcp/dlhwc/ls-208.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Final Payment or Suspension of Compensation Benefits	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:

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 proposed.pdf	http://www.dol.gov/owcp/dlhwc/ls-208.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: 67 FR 16886

Number of Respondents: 600	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21,000	0	21,000
Annual IC Time Burden (Hours)	5,250	0	5,250
Annual IC Cost Burden (Dollars)	9,500	-7,090	16,590

Documents for IC

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.