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Pre-Hearing Statement
Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
OMB: 1240-0036
IC ID: 13760
OMB.report
DOL/OWCP
OMB 1240-0036
ICR 201412-1240-010
IC 13760
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0036 can be found here:
2023-12-14 - Extension without change of a currently approved collection
2020-10-16 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
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:
Required to Obtain or Retain Benefits
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
Federal Enterprise Architecture Business Reference Module
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 %
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
3,100
0
0
0
0
3,100
Annual IC Time Burden (Hours)
527
0
0
0
0
527
Annual IC Cost Burden (Dollars)
1,402
0
-210
0
0
1,612
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.