Request for Employment Information

ICR 199801-1215-001

OMB: 1215-0105

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
13771 Migrated
ICR Details
1215-0105 199801-1215-001
Historical Active 199410-1215-002
DOL/ESA
Request for Employment Information
Extension without change of a currently approved collection   No
Regular
Approved without change 03/10/1998
Retrieve Notice of Action (NOA) 01/14/1998
  Inventory as of this Action Requested Previously Approved
03/31/2001 03/31/2001 03/31/1998
1,000 0 1,000
250 0 250
1,000 0 0

This request is used to collect information about a claimant's employment. It is necessary to determine continued eligibility for compensation payments under FECA.

None
None


No

1
IC Title Form No. Form Name
Request for Employment Information CA-1027

  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 1,000 1,000 0 0 0 0
Annual Time Burden (Hours) 250 250 0 0 0 0
Annual Cost Burden (Dollars) 1,000 0 0 1,000 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.
01/14/1998


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