Information Collection

Pre-Hearing Statement

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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form LS-18 Pre-Hearing Statement Pre-Hearing Statement	Form
LS-18 Pre-Hearing Statement ls-18.pdf www.dol.gov/esa/owcp/dlhwc/ls-18.pdf	Form

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	LS-18			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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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