Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Examination and/or Treatment (Employee Burden) New 72000 66000 0 Form LS-1 Request for Examination and/or Treatment
Request for Examination and/or Treatment (Employer Burden) Modified 72000 12000 3417840 Form LS-1 Request for Examination and/or Treatment
Total burden requested under this ICR: 144000 78000 3417840  
To view an IC, click on IC Title