Information Collection

Payment of Compensation Without Award

IC 13633 under ICR 201506-1240-011 · OMB 1240-0043.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-206 Payment of Compensation without Award Payment of Compensation Without Award	Form
LS-206 Payment of Compensation without Award ls-206 proposed.pdf www.dol.gov/owcp/dlhwc/ls-206.pdf	Form
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document

IC Title:

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 702.234

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-206			http://www.dol.gov/owcp/dlhwc/ls-206.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/GOVT-15

FR Citation: 67 FR 16870

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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	16,800	0	16,800
Annual IC Time Burden (Hours)	4,200	0	4,200
Annual IC Cost Burden (Dollars)	7,600	-1,136	8,736

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DLHWC SEA Portal		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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