Information Collection

Notice of Controversion of Right to Compensation

IC 13638 under ICR 201803-1240-002 · OMB 1240-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0042 can be found here:

Documents and Forms

Document Name Document Type
Form LS-207 Notice of Controversion of Right to Compensation Form
LS-207 Notice of Controversion of Right to Compensation ls-207 proposed.pdf www.dol.gov/owcp/dlhwc/ls-207.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Controversion of Right to Compensation	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 702.251

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-207	Notice of Controversion of Right to Compensation	ls-207 proposed.pdf	http://www.dol.gov/owcp/dlhwc/ls-207.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: 600	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	18,000	0	18,000
Annual IC Time Burden (Hours)	4,500	0	4,500
Annual IC Cost Burden (Dollars)	8,300	188	8,112

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.