Notice of Payments

ICR 201803-1240-001

OMB: 1240-0041

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2018-05-30
Supplementary Document
2018-01-31
Justification for No Material/Nonsubstantive Change
2018-01-09
Supplementary Document
2008-07-22
Supplementary Document
2008-07-22
Supplementary Document
2008-07-22
IC Document Collections
IC ID
Document
Title
Status
13642 Modified
ICR Details
1240-0041 201803-1240-001
Active 201712-1240-001
DOL/OWCP
Notice of Payments
Extension without change of a currently approved collection   No
Regular
Approved without change 08/24/2018
Retrieve Notice of Action (NOA) 06/01/2018
  Inventory as of this Action Requested Previously Approved
08/31/2021 36 Months From Approved 08/31/2018
37,800 0 37,800
6,300 0 6,300
16,112 0 16,112

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

  83 FR 7080 02/16/2018
83 FR 25714 06/01/2018
No

1
IC Title Form No. Form Name
Notice of Payments ls-208 Notice of Payments

  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 37,800 37,800 0 0 0 0
Annual Time Burden (Hours) 6,300 6,300 0 0 0 0
Annual Cost Burden (Dollars) 16,112 16,112 0 0 0 0
No
No

$63,403
No
    Yes
    Yes
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.
06/01/2018


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