Information Collection

Claim for Reimbursement-Assisted Reemployment

IC 13892 under ICR 200611-1215-002 · OMB 1215-0178.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CA-2231 Claim for Reimbursement-Assisted Reemployment	Form
CA-2231 Claim for Reimbursement Assisted Reemployment ca-2231.pdf www.dol.gov/esa/regs/compliance/owcp/ca-2231	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CA-2231	Claim for Reimbursement Assisted Reemployment	ca-2231.pdf	http://www.dol.gov/esa/regs/compliance/owcp/ca-2231	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80	0	80
Annual IC Time Burden (Hours)	40	0	40
Annual IC Cost Burden (Dollars)	34	34	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.