Information Collection

Notice of Recurrence

IC 13870 under ICR 201003-1240-009 · OMB 1240-0009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0009 can be found here:

Documents and Forms

Documents and forms in this information collection
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

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:

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-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 %

table that charts list of burden
	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

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.