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Claim For Compensation By Dependents Information Reports
CLAIM FOR COMPENSATION BY DEPENDENTS INFORMATION REPORTS
OMB: 1215-0155
IC ID: 122314
OMB.report
DOL/ESA
OMB 1215-0155
ICR 199501-1215-003
IC 122314
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0155 can be found here:
2007-03-01 - Extension without change of a currently approved collection
2004-03-12 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CLAIM FOR COMPENSATION BY DEPENDENTS INFORMATION REPORTS
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-5/5B
No
No
Form
1031/1074
No
No
Form
1085/1093
No
No
Form
1615/1617
No
No
Form
1618
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
3,615
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
3,615
0
3,615
0
0
0
Annual IC Time Burden (Hours)
1,835
0
0
0
0
1,835
Annual IC Cost Burden (Dollars)
0
0
0
0
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.