Information Collection

Pre-Hearing Statement

IC 13760 under ICR 201412-1240-010 · OMB 1240-0036.

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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

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,100	0	3,100
Annual IC Time Burden (Hours)	527	0	527
Annual IC Cost Burden (Dollars)	1,402	-210	1,612

Documents for IC

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