Information Collection

Pre-Hearing Statement

IC 13760 under ICR 201409-1240-006 · OMB 1240-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0036 can be found here:

Documents and Forms

Document Name Document Type
Form LS-18 Pre-Hearing Statement Form
LS-18 Pre-Hearing Statement ls-18.pdf www.dol.gov/owcp/dlhwc/ls-18.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Pre-Hearing Statement	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 702.317

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-18	Pre-Hearing Statement	ls-18.pdf	http://www.dol.gov/owcp/dlhwc/ls-18.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/GOVT-15	FR Citation: 67 FR 16870

Number of Respondents: 3,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,100	3,100
Annual IC Time Burden (Hours)	527	527
Annual IC Cost Burden (Dollars)	1,612	1,612

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.