NOTICE OF RECURRENCE OF DISABILITY AND CLAIM FOR CONTINUATION OF PAY/COMPENSATION

ICR 199305-1215-002

OMB: 1215-0167

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1215-0167 199305-1215-002
Historical Active 199004-1215-001
DOL/ESA
NOTICE OF RECURRENCE OF DISABILITY AND CLAIM FOR CONTINUATION OF PAY/COMPENSATION
Extension without change of a currently approved collection   No
Regular
Approved without change 07/14/1993
Retrieve Notice of Action (NOA) 05/07/1993
  Inventory as of this Action Requested Previously Approved
07/31/1996 07/31/1996 06/30/1993
2,400 0 2,400
1,200 0 1,200
0 0 0

S COMPENSATION, DISABILITY BENEFITS' THE CA-24 IS USED BY CURRENT OR FORMER FEDERAL EMPLOYEES TO CLAIM WAGE LOSS OR MEDICAL TREATMENT RESULTING FROM A RECURRENCE OF A WORK-RELATE INJURY WHILE FEDERALLY EMPLOYED. THE INFORMATION IS NECESSARY TO INSURE THE ACCURATE PAYMENT OF BENEFITS.

None
None


No

1
IC Title Form No. Form Name
NOTICE OF RECURRENCE OF DISABILITY AND CLAIM FOR CONTINUATION OF PAY/COMPENSATION CA-2A

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,400 2,400 0 0 0 0
Annual Time Burden (Hours) 1,200 1,200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
05/07/1993


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