Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Request for Examination and/or Treatment (Employee Burden) Modified 45000 41250 0 Form LS-1
Request for Examination and/or Treatment (Employer Burden) Modified 45000 7500 2544300 Form LS-1
Total burden requested under this ICR: 90000 48750 2544300  
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