Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

OMB: 1215-0202

IC ID: 13940

Information Collection (IC) Details

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Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 61.104 20 CFR 61.101

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CA-278 Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act ca-278.pdf http://www.dol.gov/esa/regs/compliance/owcp/ca-278.pdf No   Printable Only

Income Security Survivor Compensation

 

7 0
   
Private Sector Businesses or other for-profits
 
   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 140 0 0 60 0 80
Annual IC Time Burden (Hours) 70 0 0 30 0 40
Annual IC Cost Burden (Dollars) 239 0 0 239 0 0

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.

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