Information Collection

Request for Electronic Service of Orders – Waiver of Certified Mail Requirement

IC 214968 under ICR 201506-1240-012 · OMB 1240-0053.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0053 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-801 Request for Electronic Service of Orders – Waiver of Certified Mail Requirement	Form
LS-801 Waiver of Service by Registered or Certified Mail for Em LS-801.pdf www.dol.gov/owcp/dlhwc/LS-801.pdf	Form
LS-802 Waiver of Service by Registered or Certified Mail for Cl LS-802.pdf www.dol.gov/owcp/dlhwc/LS-802.pdf.	Form

IC Title:

Request for Electronic Service of Orders â Waiver of Certified Mail Requirement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 702.349

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-801	Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers	LS-801.pdf	http://www.dol.gov/owcp/dlhwc/LS-801.pdf	Yes	Yes	Fillable Fileable Signable
Form	LS-802	Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives	LS-802.pdf	http://www.dol.gov/owcp/dlhwc/LS-802.pdf.	Yes	Yes	Fillable Fileable Signable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/ESA-15

FR Citation: 67 FR 16870

Number of Respondents: 9,240

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 66 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	9,240	-4,760	14,000
Annual IC Time Burden (Hours)	770	0	770
Annual IC Cost Burden (Dollars)	0	-13,252	13,252

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.