Information Collection

Pre-Hearing Statement

IC 13760 under ICR 200710-1215-003 · OMB 1215-0085.

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/esa/owcp/dlhwc/ls-18.pdf Form

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: Mandatory

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/esa/owcp/dlhwc/ls-18.pdf	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title: DOL/GOVT-15	FR Citation: 58 FR 49599

Number of Respondents: 5,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,400	0	5,400
Annual IC Time Burden (Hours)	918	0	918
Annual IC Cost Burden (Dollars)	2,376	376	2,000

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.