Request for State or Federal Workers' Compensation Information

Request for State or Federal Workers' Compensation Information

OMB: 1215-0060

IC ID: 13703

Information Collection (IC) Details

View Information Collection (IC)

Request for State or Federal Workers' Compensation Information
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.535

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-905 Request for State or Federal Workers' Compensation Information CM-905.doc No   Paper Only

Income Security Survivor Compensation

DOL/ESA-30  67 FR 16878

1,400 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 1,400 0 0 -200 0 1,600
Annual IC Time Burden (Hours) 350 0 0 -50 0 400
Annual IC Cost Burden (Dollars) 616 0 0 -384 0 1,000

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