Request for Electronic Service of Orders - Waiver of Certified Mail Requirement

Forms and Documents

Document Name	Status
Form LS-802 Request for Electronic Service of Orders – Waiver of Certified Mail Requirement Form	Modified
1240-0053 Justification - Waiver of Certified Mail Requirements (LS-801 and LS-802).docx Justification for No Material/Nonsubstantive Change	2020-09-16
Privacy Act Systems DOL-OWCP-3.pdf Supplementary Document	2019-02-04
OMB - Supporting Statement for 1240-0053 (LS801-802) 2018.docx Supporting Statement A	2020-09-09

IC Document Collections

IC ID	Document Title	Status
214968	Request for Electronic Service of Orders – Waiver of Certified Mail Requirement Form	Modified

ICR Details

OMB Control No: 1240-0053	ICR Reference No: 202008-1240-057
Status: Received in OIRA	Previous ICR Reference No: 201811-1240-002
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Request for Electronic Service of Orders - Waiver of Certified Mail Requirement
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/15/2020

	Requested	Previously Approved
Expiration Date	04/30/2022	04/30/2022
Responses	14,000	9,240
Time Burden (Hours)	770	770
Cost Burden (Dollars)	0	0

---

Abstract: These forms waive the requirement for orders to be delivered by certified mail.

---

Authorizing Statute(s): US Code: 33 USC 919(e) Name of Law: Longshore and Harbor Workers' Compensation Act
   US Code: 33 USC 939(a)(1) Name of Law: Longshore and Harbor Workers' Compensation Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 54617	10/30/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 7133	03/01/2019
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Electronic Service of Orders – Waiver of Certified Mail Requirement	LS-802, LS-801	Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives ,   Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers

---

ICR Summary of Burden

	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	14,000	9,240	0	4,760	0	0
Annual Time Burden (Hours)	770	770	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $6,619

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/15/2020

---