Notice of Controversion of Right to Compensation

ICR 202105-1240-002

OMB: 1240-0042

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-07-01
Supplementary Document
2021-06-29
Supporting Statement A
2021-06-29
Supplementary Document
2008-10-20
Supplementary Document
2008-06-19
IC Document Collections
ICR Details
1240-0042 202105-1240-002
Received in OIRA 202008-1240-055
DOL/OWCP
Notice of Controversion of Right to Compensation
Revision of a currently approved collection   No
Regular 07/01/2021
  Requested Previously Approved
36 Months From Approved 09/30/2021
19,250 18,000
4,813 4,500
2,118 296

Form LS-207 is used by insurance carriers and self-insured employers to controvert claims under the Longshore Act and extensions.

US Code: 33 USC 914(d) Name of Law: Longshore and Harbor Worker's Compensation Act
  
None

Not associated with rulemaking

  86 FR 19905 04/15/2021
86 FR 35137 07/01/2021
No

1
IC Title Form No. Form Name
Notice of Controversion of Right to Compensation LS-207 Notice of Controversion of Right to Compensation

  Total Request 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 19,250 18,000 0 0 1,250 0
Annual Time Burden (Hours) 4,813 4,500 0 0 313 0
Annual Cost Burden (Dollars) 2,118 296 0 1,822 0 0
No
No
Burden time and cost have increased due to an increase in the number of claims controverted and subsequent controversion forms filed. Burden cost has been reduced since forms can now be submitted electronically using our Secure Electronic Access Portal (SEAPortal), however, a miscalculation of the cost burden in the previous submission has resulted in an increase in cost burden showing in this submission.

$64,803
No
    Yes
    Yes
No
No
No
No
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.
07/01/2021


© 2024 OMB.report | Privacy Policy