Information Collection

Claim for Reimbursement-Assisted Reemployment

IC 13938 under ICR 200811-1215-005 · OMB 1215-0200.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ca-1108 Claim for Reimbursement-Assisted Reemployment	Form and Instruction
ca-1108 Statement of Recovery revised 1108 5-04-09[1][1].doc www/dol.gov/esa/owcp/regs/compliance/ca-1108.pdf	Form and Instruction

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:

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 and Instruction	ca-1108	Statement of Recovery	revised 1108 5-04-09[1][1].doc	http://www/dol.gov/esa/owcp/regs/compliance/ca-1108.pdf	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/GOVT-1

FR Citation: 67 FR 16826

Number of Respondents: 25

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	25	-2,675	-500	3,200
Annual IC Time Burden (Hours)	13	-1,337	-170	1,520
Annual IC Cost Burden (Dollars)	11	-1,204	215	1,000

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.