Transcription of Pre-Hearing Statement U.S. Department of Labor - DOL
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Pre-Hearing Statement U.S. Department of Labor - DOL
Pre-Hearing StatementLongshore and Harbor Workers' Department of LaborOffice of Workers' Compensation ProgramsExpire: 1/31/2024 This form will be used by OWCP to refer the claim for a formal hearing . Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Carrier Employee's name (Last, first, middle)3. Name, address and phone number of party's representative:2. Name, address and phone number of party on whose behalf this form is submitted:Telephone Briefly state the facts of the claim:5. State the issues on which the parties have reached agreement:6. State the issues you will present for resolution at formal hearing :7. List the names of witnesses who will testify in person on your behalf at formal hearing . Also list reports that are to be submitted in lieu of live testimony:8.
comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, 200 Constitution Avenue, NW, Room S-3229, Washington, D.C. 20210, and reference the OMB Control Number. DO NOT SEND COMPLETED FORMS TO THIS OFFICE. Form LS-18 Rev. Oct. 2020
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