Information Collection

Rehablitation Plan and Award

IC 13717 under ICR 200712-1215-003 · OMB 1215-0067.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OWCP-16 Rehablitation Plan and Award	Form
OWCP-16 Rehabilitation Plan and Award OWCP-16 (current).pdf www.dol.gov/esa/regs/compliance/owcp/OWCP-16.pdf	Form
OWCP-16 Rehabilitation Plan and Award Draft OWCP-16 with proposed changes December 2007.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 702.507 20 CFR 10.519 20 CFR 702.506 20 CFR 10.518

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	OWCP-16	Rehabilitation Plan and Award	OWCP-16 (current).pdf	http://www.dol.gov/esa/regs/compliance/owcp/OWCP-16.pdf	Yes	No	Fillable Printable
Form	OWCP-16	Rehabilitation Plan and Award	Draft OWCP-16 with proposed changes December 2007.doc		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/GOVT-1(FECA);DOL/ESA-15(LHWCA)

FR Citation: 67 FR 16815

Number of Respondents: 7,000

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	Previously Approved
Annual Number of Responses for this IC	7,000	7,000
Annual IC Time Burden (Hours)	3,500	3,500
Annual IC Cost Burden (Dollars)	0	0

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.