Information Collection

Pre-Hearing Statement

IC 13760 under ICR 201703-1240-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
DLHWC Seaportal.pdf DLHWC SEA Portal	IC Document

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	https://www.dol.gov/owcp/dlhwc/ls-18.pdf	Yes	Yes	Fillable Fileable

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: 3,513

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 13 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,513	413	3,100
Annual IC Time Burden (Hours)	586	59	527
Annual IC Cost Burden (Dollars)	1,742	340	1,402

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DLHWC SEA Portal	DLHWC Seaportal.pdf	09/24/2014

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