Information Collection

FECA Medical Report Forms, Claim for Compensation

IC 38454 under ICR 200501-1215-002 · OMB 1215-0103.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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Information Collection (IC) Details

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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-1090	No	No
Form	CA-1303	No	No
Form	CA-1332	No	No
Form	OWCP-5A/5B/5C	No	No
Form	CA-16/CA-17	No	No
Form	CA-20	No	No
Form	CA-1305	No	No
Form	CA-1087	No	No
Form	CA-7	No	No
Form	CA-1331	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 287,660	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	Previously Approved
Annual Number of Responses for this IC	287,660	287,660
Annual IC Time Burden (Hours)	29,403	29,403
Annual IC Cost Burden (Dollars)	106,000	106,000

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.