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Notice of Final Payment or Suspension of Compensation Benefits
Notice of Final Payment or Suspension of Compensation Benefits
OMB: 1215-0024
IC ID: 13642
OMB.report
DOL/ESA
OMB 1215-0024
ICR 200807-1215-001
IC 13642
( )
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
Federal Enterprise Architecture Business Reference Module
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15,000
0
0
-7,722
0
22,722
Annual IC Time Burden (Hours)
3,750
0
0
-1,931
0
5,681
Annual IC Cost Burden (Dollars)
11,550
0
0
-4,450
0
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.