Information Collection

Notice of Final Payment or Suspension of Compensation Benefits

IC 13642 under ICR 201003-1240-041 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form LS-208 proposed Notice of Final Payment or Suspension of Compensation Benefits Form
LS-208 proposed Notice of Final Payment or Suspension of Compensation Be ls-208 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-208.pdf Form
ls-208 current.pdf Notice of Final Payment or Suspension of Compensation Benefits IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Final Payment or Suspension of Compensation Benefits	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 702.236 20 CFR 702.235

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-208 proposed	Notice of Final Payment or Suspension of Compensation Benefits	ls-208 proposed.pdf	http://www.dol.gov/esa/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/ESA-15	FR Citation: 58 FR 49599

Number of Respondents: 500	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 1 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,000	-7,722	22,722
Annual IC Time Burden (Hours)	3,750	-1,931	5,681
Annual IC Cost Burden (Dollars)	11,550	-4,450	16,000

Documents for IC

Title	Document	Date Uploaded
Notice of Final Payment or Suspension of Compensation Benefits	ls-208 current.pdf	11/17/2008

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