OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Notice of Final Payment or Suspension of Compensation Benefits

ICR 201611-1240-003 · OMB 1240-0041 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form LS-208 Notice of Final Payment or Suspension of Compensation Benefits Form Modified Available
Notice to OMB Reviewer - Non Material Change for 1240-0041 (Nov 2016).docx Justification for No Material/Nonsubstantive Change Uploaded 2016-11-16 Available
Justification for non-material change.docx Justification for No Material/Nonsubstantive Change Uploaded 2014-09-30 Available
OMB - Supporting Statement for 1240-0041 (LS-208) March 2015.doc Supporting Statement A Uploaded 2015-03-30 Available
20CFR702_702_236 - Penalty for failure to report termination of payments.htm Supplementary Document Uploaded 2008-07-22 Available
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 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13642 Notice of Final Payment or Suspension of Compensation Benefits Form Modified
ICR Details
1240-0041 201611-1240-003
Historical Active 201411-1240-003
DOL/OWCP
Notice of Final Payment or Suspension of Compensation Benefits
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 11/28/2016
Retrieve Notice of Action (NOA) 11/25/2016
  Inventory as of this Action Requested Previously Approved
05/31/2018 05/31/2018 05/31/2018
21,000 0 21,000
5,250 0 5,250
9,500 0 9,500
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
  79 FR 71130 12/01/2014
80 FR 10720 02/27/2015
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 21,000 0 0 0 0
Annual Time Burden (Hours) 5,250 5,250 0 0 0 0
Annual Cost Burden (Dollars) 9,500 9,500 0 0 0 0
No
No
$63,403
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.
11/25/2016