Notice of Payments

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0041 can be found here:

Documents and Forms

Document Name Document Type
Form ls-208 Notice of Payments Form and Instruction
ls-208 Notice of Payments ls-208.pdf www.dol.gov/owcp/dlhwc/ls-208.pdf Form and Instruction
ls-208 Notice of Payments ls-208.pdf www.dol.gov/owcp/dlhwc/ls-208.pdf Form and Instruction
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Payments	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 702.234 20 CFR 702.235

Information Collection Instruments:

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.pdf	https://www.dol.gov/owcp/dlhwc/ls-208.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/ESA-15	FR Citation: 67 FR 16886

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: 40 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	37,800	0	37,800
Annual IC Time Burden (Hours)	6,300	0	6,300
Annual IC Cost Burden (Dollars)	357	-15,755	16,112

Documents for IC

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.