Claim for Compensation by Dependents Information Reports

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0155 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

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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.	Available Electronically?	Can Be Submitted Electronically?
Form	CA-5B	No	No
Form	CA-5	No	No
Form	CA-1085	No	No
Form	CA-1093	No	No
Form	CA-1618	No	No
Form	CA-1617	No	No
Form	CA-1615	No	No
Form	CA-1031	No	No
Form	CA-1074	No	No

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 Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,615	0	3,615
Annual IC Time Burden (Hours)	1,835	0	1,835
Annual IC Cost Burden (Dollars)	1,000	1,000	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.