OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Notice of Final Payment or Suspension of Compensation Benefits

ICR 201003-1240-041 · OMB 1240-0041 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form LS-208 proposed Notice of Final Payment or Suspension of Compensation Benefits Form Modified Repair queued
OMB - 1215-0024 - LS-208 Supporting Statement - 11-2008.doc Supporting Statement A Uploaded 2008-11-25 Available
20CFR702_702_236 - Penalty for failure to report termination of payments.htm Supplementary Document Uploaded 2008-07-22 Repair queued
20CFR702_702_235 - Report by employer of final payment of compensation.htm Supplementary Document Uploaded 2008-07-22 Repair queued
33 USC 914(g).doc Supplementary Document Uploaded 2008-07-22 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
13642 Notice of Final Payment or Suspension of Compensation Benefits Form Modified
ICR Details
1240-0041 201003-1240-041
Historical Active 200512-1215-002
DOL/OWCP
Notice of Final Payment or Suspension of Compensation Benefits
Extension without change of a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
01/31/2012 36 Months From Approved
15,000 0 22,722
3,750 0 5,681
11,550 0 16,000
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(g) Name of Law: Longshore and Harbor Workers' Compensation Act
  
None
Not associated with rulemaking
  73 FR 45790 08/06/2008
73 FR 73349 12/02/2008
No
1
IC Title Form No. Form Name
Notice of Final Payment or Suspension of Compensation Benefits LS-208 proposed Notice of Final Payment or Suspension of Compensation Benefits
  Total Approved 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 15,000 22,722 0 0 -7,722 0
Annual Time Burden (Hours) 3,750 5,681 0 0 -1,931 0
Annual Cost Burden (Dollars) 11,550 16,000 0 0 -4,450 0
No
No
The burden hours for this information collection have decreased from the previous submission of 5,681 to 3,750, which is an adjustment of -1,931 burden hours. Improved technology allows us to obtain the actual number of forms received each year from the LongShore Case Management System database and allows for the completion of the form electronically. The reduction in the number of forms received is also due to reduced reporting under the Act.
$43,334
No
No
Uncollected
Uncollected
Uncollected
Uncollected
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.
12/02/2008