Notice of Controversion of Right to Compensation

Documents and Forms

Document Name Document Type
Form LS-207 Notice of Controversion of Right to Compensation Form
LS-207 Notice of Controversion of Right to Compensation LS-207 2024.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf Form
LS-207 Notice of Controversion of Right to Compensation LS-207 2024.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-207	Notice of Controversion of Right to Compensation	LS-207 2024.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: 89 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	23,928	4,678	19,250
Annual IC Time Burden (Hours)	5,982	1,169	4,813
Annual IC Cost Burden (Dollars)	1,858	-260	2,118

Documents for IC

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.