Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1240-0036	ICR Reference No: 201703-1240-001
Status: Historical Active	Previous ICR Reference No: 201506-1240-010
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Longshore and Harbor Workers' Compensation Act Pre-Hearing Statement
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/30/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/29/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2017
Responses	3,513	0	3,100
Time Burden (Hours)	586	0	527
Cost Burden (Dollars)	1,742	0	1,402

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	3,513	3,100	413
Annual Time Burden (Hours)	586	527	59
Annual Cost Burden (Dollars)	1,742	1,402	340

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: 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.

Annual Cost to Federal Government: $11,014

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Cheryl Jordan 202 693-0289 jordan.cheryl@dol.gov