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Federal forms, ICRs, and supporting documents

Information Collection

Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)

IC 13785 under ICR 200701-1215-009 · OMB 1215-0116.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722)
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 10.735

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CA-721 Notice of Law Enforcement Officer's Injury or Occupational Disease CA-721.pdf http://www.dol.gov/esa/regs/compliance/owcp/ca-721.pdf Yes No Fillable Printable
Form and Instruction CA-722 Notice of Law Enforcement Officer's Death CA-722.pdf http://www.dol.gov/esa/regs/compliance/owcp/ca-722.pdf Yes No Fillable Printable

Income Security Survivor Compensation

DOL/GOVT-1  67 FR 16826

30 0
   
State, Local, and Tribal Governments
 
   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 30 0 0 7 0 23
Annual IC Time Burden (Hours) 40 0 0 9 0 31
Annual IC Cost Burden (Dollars) 13 0 0 13 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.