Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement

ICR 201703-1240-001

OMB: 1240-0036

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2014-03-04
Supplementary Document
2014-03-04
Supporting Statement A
2017-08-25
IC Document Collections
IC ID
Document
Title
Status
13760 Modified
ICR Details
1240-0036 201703-1240-001
Active 201506-1240-010
DOL/OWCP
Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
Extension without change of a currently approved collection   No
Regular
Approved without change 10/30/2017
Retrieve Notice of Action (NOA) 08/29/2017
  Inventory as of this Action Requested Previously Approved
10/31/2020 36 Months From Approved 10/31/2017
3,513 0 3,100
586 0 527
1,742 0 1,402

Form LS-18 is used to refer cases to the Office of Administrative Law Judges for formal hearing under the Longshore and Harbor Workers' Compensation Act.

US Code: 33 USC 939(a) Name of Law: Longshore and Harbor Workers' Compensation Act
  
None

Not associated with rulemaking

  82 FR 15373 03/28/2017
82 FR 41058 08/29/2017
No

1
IC Title Form No. Form Name
Pre-Hearing Statement LS-18 Pre-Hearing Statement

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,513 3,100 0 0 413 0
Annual Time Burden (Hours) 586 527 0 0 59 0
Annual Cost Burden (Dollars) 1,742 1,402 0 0 340 0
No
No
There is an increase of 413 responses since the last clearance submission due to an increase in the actual number of forms received over the last year. There have been corresponding changes for time (a 59 hour increase) and other costs burden (a $340 increase). The latter includes the fact, the agency is now accounting for the respondent cost to print Form LS-18.

$11,014
No
    No
    No
No
No
No
Uncollected
Cheryl Jordan 202 693-0289 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
08/29/2017


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