Notice of Controversion of Right to Compensation

ICR 202008-1240-055

OMB: 1240-0042

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2020-10-02
Supporting Statement A
2020-09-09
Supplementary Document
2008-10-20
Supplementary Document
2008-06-19
IC Document Collections
IC ID
Document
Title
Status
13638 Modified
ICR Details
1240-0042 202008-1240-055
Received in OIRA 201803-1240-002
DOL/OWCP
Notice of Controversion of Right to Compensation
No material or nonsubstantive change to a currently approved collection   No
Regular 12/15/2020
  Requested Previously Approved
09/30/2021 09/30/2021
18,000 18,000
4,500 4,500
296 8,300

Form LS-207 is used by insurance carriers and self-insured employers to controvert claims under the Longshore Act and extensions.

US Code: 33 USC 914(d) Name of Law: Longshore and Harbor Worker's Compensation Act
  
None

Not associated with rulemaking

  83 FR 9869 03/08/2018
83 FR 25717 06/04/2018
No

1
IC Title Form No. Form Name
Notice of Controversion of Right to Compensation LS-207 Notice of Controversion of Right to Compensation

  Total Request 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 18,000 18,000 0 0 0 0
Annual Time Burden (Hours) 4,500 4,500 0 0 0 0
Annual Cost Burden (Dollars) 296 8,300 0 -8,004 0 0
No
No

$57,384
No
    Yes
    Yes
No
No
No
No
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.
12/15/2020


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