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Federal forms, ICRs, and supporting documents

Information Collection Request

Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement

ICR 202311-1240-002 · OMB 1240-0036 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form LS-18 Pre-Hearing Statement Form and Instruction Modified Repair queued
SUPPORTING STATEMENT 1240-0036 FINAL_MN_clean.docx Supporting Statement A Uploaded 2023-12-08 Repair queued
DOL_OWCP-3 _ U.S.pdf Supplementary Document Uploaded 2023-12-06 Repair queued
20 CFR 702 317.pdf Supplementary Document Uploaded 2014-03-04 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
13760 Pre-Hearing Statement Form and Instruction Modified
ICR Details
1240-0036 202311-1240-002
Received in OIRA 202005-1240-004
DOL/OWCP
Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
Extension without change of a currently approved collection   No
Regular 12/14/2023
  Requested Previously Approved
36 Months From Approved 01/31/2024
8,422 3,800
1,432 646
0 1,102
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.
US Code: 33 USC 939(a) Name of Law: Longshore and Harbor Workers' Compensation Act
  
None
Not associated with rulemaking
  88 FR 60712 09/05/2023
88 FR 86679 12/14/2023
No
1
IC Title Form No. Form Name
Pre-Hearing Statement LS-18 Pre-Hearing Statement
  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 8,422 3,800 0 0 4,622 0
Annual Time Burden (Hours) 1,432 646 0 0 786 0
Annual Cost Burden (Dollars) 0 1,102 0 0 -1,102 0
No
No
There is an increase of 785.74 burden hours and $20,218.48 burden cost since the last clearance submission due to an increase in the average number of forms received over the last 3 years which coincides with the increase in number of claims for injury received in general over the last 3 years. Over the last 3 years, the average number of referrals to the OALJ increased from 3,800 to 8,422. The annualized burden cost for mailing is reduced to zero as the submissions may be made electronically via the SEAPortal. The number of respondents increased from 3,800 to 8,422 due to the increase in average number of forms received over the last 3 years which coincides with the increase in number of claims for injury received in general over the last 3 years. There was an increase of $21,723.72 in the cost to the government since the last clearance submission due to an increase in the average number of forms received over the last 3 years which coincides with the increase in number of claims received in general over the last 3 years. Over the last 3 years, the average number of referrals to the OALJ increased from 3,800 to 8,422.
$30,305
No
    No
    No
No
No
No
No
Jamie Margherio 713 651-4658 [email protected]
  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.
12/14/2023