Information Collection

Payment of Compensation Without Award

IC 13633 under ICR 201406-1240-001 · OMB 1240-0043.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0043 can be found here:

Documents and Forms

Document Name Document Type
Form LS-206 Payment of Compensation Without Award Form
LS-206 Payment of Compensation without Award ls-206 proposed.pdf www.dol.gov/owcp/dlhwc/ls-206.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Payment of Compensation Without Award	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 702.234

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-206	Payment of Compensation without Award	ls-206 proposed.pdf	http://www.dol.gov/owcp/dlhwc/ls-206.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/GOVT-15	FR Citation: 67 FR 16870

Number of Respondents: 600	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	16,800	0	16,800
Annual IC Time Burden (Hours)	4,200	0	4,200
Annual IC Cost Burden (Dollars)	8,736	84	8,652

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.