Carrier's Report of Issuance of Policy

Carrier's Report of Issuance of Policy

OMB: 1240-0004

IC ID: 190307

Information Collection (IC) Details

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Carrier's Report of Issuance of Policy
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR CFR 703.118 20 CFR CFR 703.116  (To search for a specific CFR, visit the Code of Federal Regulations.)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form LS-570 Carrier's Report of Issuance of Policy ls-570.pdf https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-570.pdf Yes Yes Fillable Fileable

Income Security General Retirement and Disability

n/a  81 FR 25863

400 0
   
Private Sector Businesses or other for-profits
 
   98 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,500 0 0 0 0 1,500
Annual IC Time Burden (Hours) 25 0 0 0 0 25
Annual IC Cost Burden (Dollars) 15 0 0 15 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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