Information Collection

Notice of Recurrence

IC 13870 under ICR 200803-1215-003 · OMB 1215-0167.

Documents and Forms

Document Name Document Type
Form ca-2a Notice of Recurrence Form and Instruction
ca-2a Claim for Recurrence ca-2a.pdf www.dol.gov/esa/regs/compliance/owcp/ca-2a.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Notice of Recurrence	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 10.104

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ca-2a	Claim for Recurrence	ca-2a.pdf	http://www.dol.gov/esa/regs/compliance/owcp/ca-2a.pdf	Yes	No	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/GOVT-1	FR Citation: 67 FR 16817

Number of Respondents: 680	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	680	-28	708
Annual IC Time Burden (Hours)	340	-14	354
Annual IC Cost Burden (Dollars)	299	299	0

Documents for IC

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.