OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Notice of Final Payment or Suspension of Compensation Benefits

ICR 201110-1240-002 · OMB 1240-0041 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form LS-208 Notice of Final Payment or Suspension of Compensation Benefits Form Modified Repair queued
OMB - Supporting Statement for 1240-0041 (LS-208).doc Supporting Statement A Uploaded 2012-01-04 Repair queued
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 Available
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 201110-1240-002
Historical Active 201003-1240-041
DOL/OWCP
Notice of Final Payment or Suspension of Compensation Benefits
Revision of a currently approved collection   No
Regular
Approved without change 02/14/2012
Retrieve Notice of Action (NOA) 01/13/2012
  Inventory as of this Action Requested Previously Approved
02/28/2015 36 Months From Approved 02/29/2012
21,000 0 15,000
5,250 0 3,750
16,590 0 11,550
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
  76 FR 67481 11/01/2011
77 FR 2088 01/13/2012
No
1
IC Title Form No. Form Name
Notice of Final Payment or Suspension of Compensation Benefits LS-208 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 21,000 15,000 0 0 6,000 0
Annual Time Burden (Hours) 5,250 3,750 0 0 1,500 0
Annual Cost Burden (Dollars) 16,590 11,550 0 0 5,040 0
No
No
The burden hours for this information collection have increased from the previous submission of 3,750 to 5,250 which is an adjustment of 1,500 burden hours. The increase is due to an increase in the number of authorized insurance carriers and self-insured employers under the Act. While not affecting the public burden, OWCP intends to make this collection available on the Internet as fillable/printable and not fileable. Item 3 in the supporting statement more fully addresses the reasoning for this change. The DOL has made certain cosmetic changes to Form LS-208, such as replacing a no longer used logo with the DOL seal. These cosmetic changes also are not expected to affect the public burden.
$63,572
No
No
No
No
No
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.
01/13/2012