Information Collection

Pre-Hearing Statement

IC 13760 under ICR 201403-1240-002 · OMB 1240-0036.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

IC Title:

Pre-Hearing Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	Pre-Hearing Statement	ls-18.pdf	http://www.dol.gov/owcp/dlhwc/ls-18.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/GOVT-15

FR Citation: 67 FR 16870

Number of Respondents: 3,100

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	3,100	-2,100	5,200
Annual IC Time Burden (Hours)	527	-357	884
Annual IC Cost Burden (Dollars)	1,612	-832	2,444

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.