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FECA Medical Report Forms, Claim for Compensation
FECA Medical Report Forms, Claim for Compensation
OMB: 1215-0103
IC ID: 13770
OMB.report
DOL/ESA
OMB 1215-0103
ICR 200507-1215-001
IC 13770
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0103 can be found here:
2008-08-07 - Extension without change of a currently approved collection
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.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CA-1090
No
No
Form
CA-1087
No
No
Form
CA-1332/CA-1332
No
No
Form
CA-1331
No
No
Form
CA-7/CA-16
No
No
Form
CA-17/CA-20
No
No
Form
CA-1305
No
No
Form
OWCP-5A/-5B/-5C
No
No
Form
CA-1303
No
No
Form
QCM-LETTERS
No
No
Federal Enterprise Architecture Business Reference Module
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:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
302,485
0
0
14,825
0
287,660
Annual IC Time Burden (Hours)
30,748
0
0
1,345
0
29,403
Annual IC Cost Burden (Dollars)
121,000
0
0
15,000
0
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.