Information Collection

Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim

IC 13697 under ICR 200704-1215-002 · OMB 1215-0058.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-2970 Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Form
CM-2970 Operator Response to Schedule for Submission of Addition CM-2970.pdf www.dol.gov/esa/regs/compliance/owcp/cm-2970.pdf	Form
CM-2970A Operator Response to Notice of Claim CM-2970a.pdf www.dol.gov/esa/regs/compliance/owcp/cm-2970a.pdf	Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 725.408 20 CFR 725.412

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	CM-2970	Operator Response to Schedule for Submission of Additional Evidence	CM-2970.pdf	http://www.dol.gov/esa/regs/compliance/owcp/cm-2970.pdf	Yes	Yes	Fillable Fileable Signable
Form	CM-2970A	Operator Response to Notice of Claim	CM-2970a.pdf	http://www.dol.gov/esa/regs/compliance/owcp/cm-2970a.pdf	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/ESA-15

FR Citation: 58 FR 49559

Number of Respondents: 8,000

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	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	8,000	-200	0	8,200
Annual IC Time Burden (Hours)	2,333	-42	666	1,709
Annual IC Cost Burden (Dollars)	3,520	0	520	3,000

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.