Information Collection

Notice of Controversion of Right to Compensation

IC 13638 under ICR 202105-1240-002 · OMB 1240-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-207 Notice of Controversion of Right to Compensation	Form and Instruction
LS-207 Notice of Controversion of Right to Compensation ls-207 5-18-21.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf	Form and Instruction
LS-207 Notice of Controversion of Right to Compensation ls-207 5-18-21.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf	Form and Instruction
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document

IC Title:

Notice of Controversion of Right to Compensation

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 702.251

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-207	Notice of Controversion of Right to Compensation	ls-207 5-18-21.pdf	https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.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: 58 FR 49599

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	19,250	0	1,250	18,000
Annual IC Time Burden (Hours)	4,813	0	313	4,500
Annual IC Cost Burden (Dollars)	2,118	1,822	0	296

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.