Payment of Compensation Without Award

ICR 201003-1240-043

OMB: 1240-0043

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2008-09-10
Supporting Statement A
2008-09-11
Supplementary Document
2008-05-08
Supplementary Document
2008-05-08
IC Document Collections
IC ID
Document
Title
Status
13633 Modified
ICR Details
1240-0043 201003-1240-043
Historical Active 200509-1215-004
DOL/OWCP
Payment of Compensation Without Award
Extension without change of a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
10/31/2011 36 Months From Approved
21,000 0 24,500
5,250 0 6,125
10,395 0 11,000

The LS-206 is used by insurance carriers and self-insurers to report the initial payment of compensation benefits to injured claimants as required by the Longshore and Harbor Workers' Compensation Act.

US Code: 33 USC 914(c) Name of Law: Longshore and Harbor Workers' Compensation Act
  
None

Not associated with rulemaking

  73 FR 31888 06/04/2008
73 FR 54170 09/18/2008
No

1
IC Title Form No. Form Name
Payment of Compensation Without Award LS-206 Payment of Compensation without Award

  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 24,500 0 0 -3,500 0
Annual Time Burden (Hours) 5,250 6,125 0 0 -875 0
Annual Cost Burden (Dollars) 10,395 11,000 0 0 -605 0
No
No
There has been an adjustment to the burden hours for this clearance. The burden hours has been reduced from 6,125 hours to 5,250 hours which is a reduction of -875 hours. The operation and maintenance costs have been reduced by -$605.00 (from $11,000 to $10,395.00). The reduction in burden hours is the result of reduced reporting under the Act due to a decrease in the number of authorized carriers and self-insurers (from 700 to 600, each of whom will submit an average of 35 responses) for an estimate of 21,000 responses. The change in operation and maintenance costs is reduced due to decrease in the number of responses received since the last clearance.

$54,650
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Cheryl Jordan 202 693-0289 jordan.cheryl@dol.gov

  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.
09/18/2008


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