FECA Medical Report Forms, Claim for Compensation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0103 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

View Information Collection (IC)

IC Title:	FECA Medical Report Forms, Claim for Compensation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CA-1332	No	No
Form	CA-1305	No	No
Form	CA-1087	No	No
Form	CA-1331	No	No
Form	CA-1303	No	No
Form	CA-16	No	No
Form	CA-1090	No	No
Form	CA-17	No	No
Form	CA-7	No	No
Form	CA-20	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 286,010	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	286,010	56	-16,674	302,628
Annual IC Time Burden (Hours)	28,990	6	-1,782	30,766
Annual IC Cost Burden (Dollars)	106,000	0	-3,000	109,000

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.