Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Examination and/or Treatment (Employee Burden) Modified 48000 44000 0 Form LS-1 Request for Examination and/or Treatment
Request for Examination and/or Treatment (Employer Burden) Modified 48000 8000 2088960 Form LS-1 Request for Examination and/or Treatment
Total burden requested under this ICR: 96000 52000 2088960  
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