Claim for Reimbursement-Assisted Reemployment

ICR 200104-1215-002

OMB: 1215-0178

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
13891 Migrated
ICR Details
1215-0178 200104-1215-002
Historical Active 199804-1215-001
DOL/ESA
Claim for Reimbursement-Assisted Reemployment
Extension without change of a currently approved collection   No
Regular
Approved without change 06/29/2001
Retrieve Notice of Action (NOA) 04/23/2001
Approved consistent with DOL's memo of 6/28/01 and on the following condition: DOL shall provide OMB with basic information on the success of the program and efforts to place form CA-2231 on the internet at the time of the next ICR submission.
  Inventory as of this Action Requested Previously Approved
06/30/2004 06/30/2004 06/30/2001
80 0 720
40 0 360
0 0 0

To aid in the employment of Federal employees with disabilities related to an injury on the job, employers submit this form to claim reimbursement for wages paid under the assisted reemployment project. This information allows for a prompt decision on payment.

None
None


No

1
IC Title Form No. Form Name
Claim for Reimbursement-Assisted Reemployment CA-2231

  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 80 720 0 0 -640 0
Annual Time Burden (Hours) 40 360 0 0 -320 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.
04/23/2001


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