Information Collection

Notice of Payments

IC 13642 under ICR 202105-1240-001 · OMB 1240-0041.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-208 Notice of Payments	Form and Instruction
LS-208 Notice of Payments ls-208 5-18-21.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-208.pdf	Form and Instruction
LS-208 Notice of Payments ls-208 5-18-21.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-208.pdf	Form and Instruction
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document

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 702.235 20 CFR 702.234

Information Collection Instruments:

table that charts list of 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 5-18-21.pdf	https://www.dol.gov/sites/dolgov/files/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/OWCP-3

FR Citation: 67 FR 16886

Number of Respondents: 550

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	33,000	0	-4,800	37,800
Annual IC Time Burden (Hours)	5,500	0	-800	6,300
Annual IC Cost Burden (Dollars)	3,630	3,273	0	357

Documents for IC

table that charts IC Documents
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.