Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement

ICR 202005-1240-004 · OMB 1240-0036 · Received in OIRA

⚠️ Notice: This information collection may be outdated.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

2023-12-14 - Extension without change of a currently approved collection

Forms and Documents

Document	Type	Status	Availability
Form LS-18 Pre-Hearing Statement	Form and Instruction	Modified	Missing upstream
Supporting Statement 1240-0036.docx	Supporting Statement A	Uploaded 2020-10-16	Available
30-day FRN (1240-0036) published.pdf	Supplementary Document	Uploaded 2020-10-16	Repair queued
60-day FRN (1240-0036) published.pdf	Supplementary Document	Uploaded 2020-10-09	Repair queued
20 CFR 702 317.pdf	Supplementary Document	Uploaded 2014-03-04	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
13760	Pre-Hearing Statement	Form and Instruction	Modified

ICR Details

OMB Control No: 1240-0036	ICR Reference No: 202005-1240-004
Status: Received in OIRA	Previous ICR Reference No: 201703-1240-001
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/16/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	3,800	3,513
Time Burden (Hours)	646	586
Cost Burden (Dollars)	1,102	1,742

Abstract: Form LS-18 is used to refer cases to the Office of Administrative Law Judges for formal hearing under the Longshore and Harbor Workers' Compensation Act.

Authorizing Statute(s): US Code: 33 USC 939(a) Name of Law: Longshore and Harbor Workers' Compensation Act

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 33201	06/01/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 65874	10/16/2020
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Pre-Hearing Statement	LS-18	Pre-Hearing Statement (Longshore and Harbor Workers' Compensation)

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,800	3,513	287
Annual Time Burden (Hours)	646	586	60
Annual Cost Burden (Dollars)	1,102	1,742	-640

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is an increase of 60 burden hours since the last clearance submission due to an increase in the actual number of forms received over the last year. There has been a decrease in the operation and maintenance cost from $$1,742.00 to $1,102.00 (-$640) due to the increase in usage of the form electronically.

Annual Cost to Federal Government: $15,182

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Cheryl Jordan 202 693-0289 [email protected]

Common Form ICR: No