Request for Examination and/or Treatment

Request for Examination and/or Treatment

OMB: 1215-0066

IC ID: 13713

Information Collection (IC) Details

View Information Collection (IC)

Request for Examination and/or Treatment
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 702.419

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form LS-1 Request for Examination and/or Treatment ls-1.pdf http://www.dol.gov/esa/dlhwc/lsforms.htm Yes No Fillable Printable

Workforce Management Labor Rights Management

DOL/GOVT-15  58 FR 49599

25,000 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 75,000 0 0 -26,250 0 101,250
Annual IC Time Burden (Hours) 81,000 0 0 -28,350 0 109,350
Annual IC Cost Burden (Dollars) 3,558,000 0 0 3,517,000 0 41,000

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