Form LS-1 is used by employers to
authorize medical treatment for injured workers and by claimants to
report findings of physical examinations and treatment
recommended.
US Code:
33
USC 939(a) Name of Law: Longshore and Harbor Workers'
Compensation Act
There is a decrease of 6,000
responses (from 96,000 to 90,000) since the last clearance
submission due to a decrease in reporting under the LHWCA. This has
resulted in a corresponding reduction of 3,250 burden hours (52,000
to 48,750). There has been a decrease in the operation and
maintenance costs from $2,085,715 to $1,484,816 due to the ability
now to submit the form electronically. The cost reduction was
slightly offset by the fact that the agency has taken on burden for
the paper and printing costs of responding.
$35,271
No
Yes
Yes
No
No
No
Uncollected
Cheryl Jordan 202 693-0289
jordan.cheryl@dol.gov
No
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.