Application for Continuation of Death Benefit for Student

Application for Continuation of Death Benefit for Student

OMB: 1240-0026

IC ID: 13739

Information Collection (IC) Details

View Information Collection (IC)

Application for Continuation of Death Benefit for Student
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.121

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction LS-266 Application for Continuation of Death Benefit for Student under the LHWCA ls-266.pdf https://www/dol.gov/owcp/dlhwc/ls-266 Yes Yes Fillable Fileable

Income Security General Retirement and Disability

DOL/OWCP-3  67 FR 16870

20 0
   
Individuals or Households
 
   50 %

  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 20 0 0 0 0 20
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 6 0 -4 0 0 10

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.

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