LS208SupportingStatement2024_MN3_CLEAN

Notice of Payments

OMB Number: 1240-0041

Expiration Date: August 31, 2024

SUPPORTING STATEMENT FOR

Notice of Payments (LS-208)

OMB CONTROL NO. 1240-0041

This ICR seeks to extend a currently approved ICR.

1. JUSTIFICATION

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

The Office of Workers' Compensation Programs administers the Longshore and Harbor Workers' Compensation Act (LHWCA). The Act provides benefits to workers injured in maritime employment on the navigable waters of the United States or in an adjoining area customarily used by an employee in loading, unloading, repairing, or building a vessel. In addition, several acts extend Longshore Act coverage to certain other employees.

Under Section 914(b) of the Longshore Act, the employer or its insurance carrier must issue payment of the first installment of compensation on or before the fourteenth day after notification of injury and notify the Director of such payment. Under Section 14(c) of the Act, the employer/carrier must immediately issue notification that payment has begun or has been suspended. Section 30(b) and (e) of the Act require the employer/carrier to file notice of payment and anytime an interim change in benefit payment is made. Section 914(g) of the Act requires the employer/carrier issue notification of final payment of compensation. Under Section 914(e), if any installment of compensation payable without an award is not paid within 14 days after it becomes due, there shall be added to such unpaid installment an amount equal to 10 percent thereof, which shall be paid at the same time, but in addition to, such installment. Filing of the report is mandatory as failure to do so is subject to a civil penalty. Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) | U.S. Department of Labor (dol.gov).

2. Indicate how, by whom, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

Employers and their insurance carriers use this form to notify OWCP District Offices when they make an initial payment of compensation, an interim change in benefit payment, or a final payment of compensation. The report is required by law. If the report were not filed, our offices would have no way to determine that a claimant has received all benefits that he/she is entitled to receive under the Act.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also, describe any consideration of using information technology to reduce burden.

To improve upon the capabilities for the public to submit DLHWC documents, OWCP created the Secure Electronic Access Portal (SEAPortal), which allows the user to upload all forms (including this one) directly into the case file. It can be accessed at https://seaportal.dol.gov/portal

We are not aware of any additional improved information technology that could potentially reduce burden. This form is electronically interactive as mandated by the Government Paperwork Elimination Act. The form is currently available on the Internet where it can be electronically-filled and submitted. The website is https://www.dol.gov/agencies/owcp/dlhwc/lsforms

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item A.2 above.

This information collection does not duplicate existing requirements. No similar information is available from any other source. Information is only available from the insurance carrier or self-insured employer since there are no other forms or reports that collect this information and the information must be filed on a case-by-case basis soon after compensation payments begin and/or are terminated in a case.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

The information is collected only from large insurance carriers and large employers who have been authorized to self-insure their liability under the Act. The information is not collected from small businesses or other small entities. As such, this information collection does not have a significant economic impact on a substantial number of small entities.

6. Describe the consequence to federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

The information is only collected when required by law at the time of initial, final or change in payment on a compensation case. It therefore cannot be collected less frequently without eliminating this method for determining a change in payment status.

7. Explain any special circumstances that would cause an information collection to be conducted in a manner:

• requiring respondents to report information to the agency more often than quarterly;

• requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it;

• requiring respondents to submit more than an original and two copies of any document;

• requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years;

• in connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study;

• requiring the use of statistical data classification that has not been reviewed and approved by OMB;

• that includes a pledge of confidentially that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or

• requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information's confidentially to the extent permitted by law.

The information is only collected when required by law at the time of initial, final or change in payment on a compensation case. It therefore cannot be collected less frequently without eliminating this method for determining a change in payment status.

8. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments. Specifically address comments received on cost and hour burden.

Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting format (if any), and on the data elements to be recorded, disclosed, or reported.

Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years -- even if the collection-of-information activity is the same as in prior periods. There may be circumstances that may preclude consultation in a specific situation. These circumstances should be explained.

Consultations are regularly held with the industry representatives during the claim adjudication process. Representatives of self-insurers and insurance carriers meet frequently with our District Directors.

A Federal Register Notice inviting public comment was published on March 18, 2024, at 89 FR 19363. No comments were received.

In addition, OWCP and Longshore leadership invite comment and feedback on processes and forms on a continual basis with regularly scheduled meetings with stakeholders including, but not limited to: four to five conferences per year during which OWCP makes presentations to stakeholders and fields their questions, comments and concerns; annual Carrier Performance Meetings with OWCP leadership and the largest carriers; special requests for in person and/or virtual meetings with stakeholders throughout the year; outreach efforts at the District Office and National Office levels; and continual communication with all stakeholders.

The Longshore Program consulted with three internal and/or external representatives to the agency involved in requesting Form LS-208 Notice of Payments. The consultation asked Longshore industry contacts for their feedback on burden estimates for information collection activities associated with requesting Form LS-208. None of the three representatives had any changes or comments on the estimated burden, so the Longshore Program is proceeding with the initial estimates published in the 60-day notice. The individuals/organizations consulted about the information collection are listed in the table below. We have redacted their last names and contact information.

Table 1: List of Internal and External Representatives

Contact	Organization	Email	Phone
Robert XXX	HII Gulf	xxx	xxx
Mike XXX	CCSI	xxx	xxx
Stephanie XXX	Deputy Director Longshore	xxx	xxx

9. Explain any decision to provide any payments or gifts to respondents, other than remuneration of contractors or grantees.

No payments or gifts are provided to respondents.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Where records pertain to specific compensation cases, the completed forms will be maintained in the claimant’s case file. Thus, the information collected is covered by Privacy Act Systems of Records, DOL/OWCP-3, published at 81 Federal Register 25765 (April 29, 2016), or as updated and republished. Otherwise, the information collected is not protected under the Privacy Act.

11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

There are no questions of a sensitive nature.

12. Provide estimates of the hour burden of the collection of information. The statement should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates. Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity, size, or complexity, show the range of estimated hour burden, and explain the reasons for the variance. General, estimates should not include burden hours for customary and usual business practices.

• If this request for approval covers more than one form, provide separate hour burden estimates for each form.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.

The burden estimates for completing the LS-208 is shown below. The number of responses for the LS-208 was obtained directly from OWCP Workers’ Compensation System (OWCS) for Fiscal Year 2023. Based on this data, 32,016 LS-208 forms will be filed each year. There are approximately 550 authorized carriers and self-insurers under the Act. We estimate each carrier and self-insured employer will file approximately 58.211 LS-208 forms. (550 carriers and self-insurers x 58.211 LS-208 forms for each company = 32,016 (rounded) estimated total LS-208 forms filed). A lost-time injury is an injury that results in loss of time from work beyond the shift or day of injury. However, the form LS-208 will only be filed in those cases in which disability exceeds 3 days, which requires the payment of compensation benefits. A Form LS-208 will therefore not be filed in every lost-time case; and in certain cases involving intermittent periods of disability, several forms may be filed for one case by an insurance carrier or self-insured employer. Depending on the severity of the injury and the length and types of disability, all or only a part of the form will be completed to reflect the amount of compensation paid in a case. Our best estimate of the time needed to complete the form is 10 minutes or .16667 hour. This estimate represents an average time since the form can be completed in less time in cases involving minor injuries and will take longer in cases involving serious injuries. This estimate is also based on the actual time taken by agency personnel to complete the form. It also includes the time needed to review and transfer the information from existing records maintained by the industry. Total burden is therefore as follows:

• 32,016 forms X .16667 hours per form = 5,336 burden hours

• The annualized burden cost to the respondents has been estimated to be approximately $128,490.88. This estimate is derived from use of the National Average Weekly Wage (NAWW) as computed by the Bureau of Labor Statistics and which is based on the national average earnings of production or nonsupervisory workers on private non-agriculture payrolls. Section 906(b) of the Act mandates the use of the NAWW in setting the maximum and minimum compensation rates under the Act and in determining the amount of annual adjustments due to permanent total disability and death beneficiaries. Since it is not possible to determine the specific occupation or wages for each person who will provide the information covered by this clearance, e.g., claims adjusters, claims managers, self-insurance administrators, secretaries, claims clerks, and other office personnel, and wages can vary considerably from person to person depending on duties and length of service, use of a national average weekly wage covering all occupations appears reasonable under the circumstances. The current applicable NAWW is $963.29. National Average Weekly Wage. The computations are therefore as follows:

• $963.29  40 hrs = $24.08/hr x 5,336 hrs = $128,490.88 annualized burden cost.

Estimated Annualized Respondent Cost and Hour Burden

Activity	No. of Respondents	No. of Responses per Respondent	Total Responses	Average Burden (Hours)	Total Burden (Hours)	Hourly Wage Rate	Total Burden Cost
LS-208	550	58.211	32,016	.16667	5,336	24.08	$128,490.88

13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

• The cost estimate should be split into two components: (a) a total capital

and start up cost component (annualized over its expected useful life); and (b) a

total operation and maintenance and purchase of service component.

The estimates should take into account costs associated with generating,

maintaining, and disclosing or providing the information. Include descriptions of

methods used to estimate major cost factors including system and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start-up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and record storage facilities.

• If cost estimates are expected to vary widely, agencies should present ranges of cost burdens and explain the reasons for the variance. The cost of purchasing or contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10), utilize the 60-day pre-OMB submission public comment process and use existing economic or regulatory impact analysis associated with the rulemaking containing the information collection, as appropriate.

• Generally, estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with requirements not associated with the information collection, (3) for reasons other than to provide information or keep records for the government, or (4) as part of customary and usual business or private practices.

There are no start-up costs. The only operation and maintenance cost is for postage and envelopes, which is based on $0.71 ($0.68 postage and $0.03 envelope). Based on data from FY 2023, 6% of respondents used the mail option, while 94% used the option to electronically upload/submit responses via SEAPortal.

Total mailed responses = 2028

Total electronic responses = 29,988

Total = 32,016

Respondent Cost using mail option for submission for the LS-208 

Total Cost for mailed responses = $1,439.88 [($0.68 (postage) + $0.03 (envelopes)) x 2028 (forms)] = $1,440.00 rounded

14. Provide estimates of the annualized cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operational expenses (such as equipment, overhead, printing, and support staff), any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 into a single table.

The cost to the government has been estimated to be $240,018.08. This estimate was determined by taking into consideration analysis costs associated with the review of all forms associated with this clearance. Analysis and handling costs were determined by applying the hourly rate of a GS-12, step 5 workers’ compensation claims examiner taken from the 2023 Rest of the U.S. pay chart ($44.98) to the 10 minutes it takes to review each form. The annual review hours were determined by applying an estimate of .16667 hours or 10 minutes for the review and analysis of each form. The computations are therefore as follows:

Form	Grade/Rate	Analysis (Hours)	# of Forms	Federal Cost
LS-208	GS-12s5/$44.98	.16667	32,016	$240,018.08

Total review cost to the government is 32,016(responses) x .16667 hrs x $44.98 (grade 12, step 5) = $240,018.08.

Thus, the total cost to the government is $240,018.08 + ($66,000.00/10 = $6,600) * = $246,618.08 or $246,618.00 rounded.

*The cost to maintain SEAPortal is $66,000 so this has been divided over the total Information Collection Requests (ICRs) that are impacted.

15. Explain the reasons for any program changes or adjustments.

The reduction in hour burden is due to a reduction in the number of forms received. Cost burden to respondents has decreased due to the decrease in responses and greater percentage of respondents filing their LS-208 forms electronically.

16. For collections of information whose results will be published, outline plans for tabulations, and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

The information collected will not be published.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

The expiration date will be displayed on the form.

18. Explain each exception to the certification statement.

There are no exceptions to the certification.

B. COLLECTIONS OF INFORMATON EMPLOYING STATISTICAL METHODS.

Statistical methods are not used in these collections of information.

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