Notice of Payments

Notice of Final Payment or Suspension of Compensation Benefits

OMB: 1240-0041

IC ID: 13642

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Notice of Payments
 
No Modified
 
Mandatory
 
20 CFR 702.234 20 CFR 702.235

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ls-208 Notice of Payments ls-208 NEW Proposed (2).pdf https://www.dol.gov/owcp/dlhwc/ls-208.pdf Yes Yes Fillable Fileable

Income Security General Retirement and Disability

DOL/ESA-15  67 FR 16886

600 0
   
Private Sector Businesses or other for-profits
 
   1 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 37,800 0 16,800 0 0 21,000
Annual IC Time Burden (Hours) 6,300 0 1,050 0 0 5,250
Annual IC Cost Burden (Dollars) 16,112 0 6,612 0 0 9,500

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.

© 2024 OMB.report | Privacy Policy