Statement of Recovery

Statement of Recovery Forms

OMB: 1215-0200

IC ID: 188783

Information Collection (IC) Details

View Information Collection (IC)

Statement of Recovery
 
No New
 
Required to Obtain or Retain Benefits
 
20 CFR 10.710 20 CFR 10.707 (e)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ca-1122 Statement of Recovery correction 1122 5-4-09[1].doc http://www/dol.gov/esa/owcp/regs/compliance/ca-1122.pdf Yes No Fillable Printable

General Government Central Personnel

DOL/GOVT-1 (Office of Worker's Compensation Programs, Federal Employees' Compemsation Act File  67 FR 16827

300 0
   
Individuals or Households
 
   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 300 0 0 300 0 0
Annual IC Time Burden (Hours) 75 0 0 75 0 0
Annual IC Cost Burden (Dollars) 135 0 0 135 0 0

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.

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