Notice Of Recurrence Of Disability And Claim For Continuation Of Pay/compensation

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

OMB: 1215-0167

IC ID: 122353

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NOTICE OF RECURRENCE OF DISABILITY AND CLAIM FOR CONTINUATION OF PAY/COMPENSATION
 
No Migrated
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-2A No No


    

2,400 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,400 0 0 0 0 2,400
Annual IC Time Burden (Hours) 1,200 0 0 0 0 1,200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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