Notice of Payments

ICR 202105-1240-001

OMB: 1240-0041

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-07-01
Supplementary Document
2021-06-29
Supporting Statement A
2021-06-29
Supplementary Document
2021-05-12
Supplementary Document
2021-05-12
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 202105-1240-001
Received in OIRA 202008-1240-054
DOL/OWCP
Notice of Payments
Revision of a currently approved collection   No
Regular 07/01/2021
  Requested Previously Approved
36 Months From Approved 08/31/2021
33,000 37,800
5,500 6,300
3,630 357

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(b) Name of Law: Longshore and Harbor Workers' Compensation Act
   US Code: 33 USC 914(c) and (g) Name of Law: Longshore and Harbor Workers' Compensation Act
   US Code: 33 USC 930(b) and (e) Name of Law: Longshore and Harbor Workers' Compensation Act
   US Code: 33 USC 914 Name of Law: Longshore and Harbor Workers' Compensation Act
  
None

Not associated with rulemaking

  86 FR 19906 04/15/2021
86 FR 35138 07/01/2021
No

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

  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 33,000 37,800 0 0 -4,800 0
Annual Time Burden (Hours) 5,500 6,300 0 0 -800 0
Annual Cost Burden (Dollars) 3,630 357 0 3,273 0 0
No
No
Burden time and cost have been reduced due to a reduction in the number of payments made and subsequent payment forms received. In addition, forms can now be submitted electronically using our Secure Electronic Access Portal (SEAPortal). However, a miscalculation in cost burden in the previous submission has resulted in an increase in cost burden showing in this submission.

$231,440
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.
07/01/2021


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