Information Collection

Feca Medical Report Forms

IC 168479 under ICR 198503-1215-004 · OMB 1215-0103.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0103 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	FECA MEDICAL REPORT FORMS	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CA-16, 17	No	No
Form	20, 28A, 28B	No	No
Form	1090, 1302	No	No
Form	1303, 1304	No	No
Form	1306, 1308	No	No
Form	1316, 1331	No	No
Form	OWCP	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 480,350	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	480,350	480,350
Annual IC Time Burden (Hours)	216,700	216,700
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.