Information Collection

Owcp Representative Fee Request: Feca (ca-38), Black Lung (cm-972), And Longshore (20 Cfr 702.132) Programs

IC 122085 under ICR 198610-1215-004 · OMB 1215-0078.

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Documents and Forms

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Information Collection (IC) Details

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IC Title:	OWCP REPRESENTATIVE FEE REQUEST: FECA (CA-38), BLACK LUNG (CM-972), AND LONGSHORE (20 CFR 702.132) PROGRAMS	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CA-38 (FECA)				No	No
Form	CA-972 (BL)				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 15,600	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	15,600	1,100	14,500
Annual IC Time Burden (Hours)	10,672	489	10,183
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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