Information Collection

Pre-Hearing Statement

IC 13760 under ICR 202005-1240-004 · 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⚠️ Notice: This information collection may be referencing outdated material.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 and Instruction
LS-18 Pre-Hearing Statement (Longshore and Harbor Workers' Com Form LS-18.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-18.pdf	Form and Instruction

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 and Instruction	LS-18	Pre-Hearing Statement (Longshore and Harbor Workers' Compensation)	Form LS-18.pdf	https://www.dol.gov/sites/dolgov/files/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/OWCP-3

FR Citation: 83 FR 25766

Number of Respondents: 3,800

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,800	287	3,513
Annual IC Time Burden (Hours)	646	60	586
Annual IC Cost Burden (Dollars)	1,102	-640	1,742

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.