Information Collection

Claim for Reimbursement-Assisted Reemployment

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claim for Reimbursement-Assisted Reemployment	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:

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 %

	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

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.